Experimental transplantation of small joints by microvascular anastomoses.

Metacarpophalangeal joints in dogs were transplanted with microvascular anastomoses. Some were transplanted as half-joints, others as whole joints, and these dogs were followed for up to 5 1/2 months. When a half-joint was transplanted within the foot, the joint movement became restricted but the vascularized half-joints were well preserved with only slight damage and well-preserved epiphyseal plates--compared to severe damage of the articular cartilage and destruction of the epiphyseal plates in the non-vascularized joint transplants. Vascularized whole joint transplants within the foot were indistinguishable macroscopically and microscopically from normal joints, and they had only a slight restriction of joint movement. They took up tetracycline from the circulation, demonstrating their viability.

Soft tissue response to textured silicone implants in an animal experiment.

In a study on rats to assess soft tissue response to textured silicone implants, ellipsoid 15 x 20 mm pieces from the bag of a Biocell breast prosthesis were implanted under the dorsal skin. Histological examinations including immunohistochemical detection of myofibroblasts were made 2 weeks and 1, 3, 6, and 8 months after implantation (12 specimens for each time interval). On the smooth side of the implant, which served as a control, the thin connective tissue capsule characteristically seen with silicone elastomer implants developed within a month. Myofibroblasts were present after the first month and appeared to reach a peak 3 months after implantation, after which they showed marked regression. On the textured side of the implant, villous processes were a characteristic feature of the capsules; originating in a common basal layer, they penetrated into the cavities of the implant. Collagen deposits and myofibroblasts only became more evident during the third month after implantation; they were limited to the common basal layer of the capsule, though foreign body reaction persisted in the villous processes until the end of the experiment. The experimental study, limited to an 8-month period after implantation, showed that texturing of the implant surface prevents compact capsule development and considerably delays or inhibits the maturation process.

Variations in the course of the thenar motor branch of the median nerve.

In a prospective study of 80 operations in 61 patients for carpal tunnel syndrome, special attention was given to the course of the thenar motor branch and its variations. An anomalous origin of the branch was found in 21%. Multiple motor branches occurred in 12.5%. Seventeen patients had operations on both hands, but anomalies were often found in one side only. Special attention is drawn to an additional anomaly where the motor branch lies superficially to the retinaculum buried in a hypertrophic preligamentous muscle. If this anomaly is not borne in mind, the nerve can easily be injured during splitting of the flexor retinaculum. We found this variation in 9% of our patients, but it is rarely mentioned in the literature and in many large series it is not described at all.

The many-tailed flap for multiple finger injuries.

Using the principle of opposing flaps, multiple soft tissue defects on several fingers of one hand can be covered in one operation with a series of carefully designed opposing flaps. The donor site can be closed by suture leaving a linear, relatively inconspicuous scar.

Breast reconstruction after mastectomy.

Recent developments in prosthetics and surgical techniques have made breast reconstruction a well-established procedure, producing satisfactory results even in situations with heavy scarring and after excision of the pectoral muscle. Close cooperation between general surgeon, oncologist and plastic surgeon is needed for counseling of patients toward reconstruction. Those patients with relatively early disease and a strong desire for reconstruction were selected. Of the 15 patients who underwent breast reconstruction in our unit, 10 had only a silicone prosthesis implanted, but 5 also needed a myocutaneous flap from the latissimus dorsi to compensate for deficient soft tissues. Although some postoperative complications occurred, they were either self-limited or could easily be corrected at a later stage. Two-thirds of the patients were very pleased with the results and none regarded the reconstruction as a failure.

Spontaneous regression of metastatic melanoma.

Spontaneous regression of malignant melanoma is a well-known but rare event. It seems to be caused by immunological enhancement similar to the regression observed after intralesional injection of Bacille Calmette-Guérin into cutaneous melanoma metastases. A patient is presented in whom an incisional biopsy of a metastatic melanoma in an inguinal lymph node was followed by complete disappearance of the metastasis. Reviewing the literature, several similar patients were found in whom spontaneous regression of a metastatic melanoma occurred after an incomplete excision or biopsy of the tumor. It appears that in rare instances, an unspecific mechanical stimulus may trigger an increase in immunocompetence, although laboratory evidence for this has only rarely been produced. A plea is made for serial immunological studies in consecutive patients with melanoma, to further elucidate these puzzling phenomena.

A simple dressing to keep secreting wounds dry.

A simple method to dress secreting wounds using readily available materials is described. The dressing allows secretions and blood to pass freely through, leaving the wound clean and dry.

Facial reconstruction in partial lipodystrophy.

Lipodystrophy is a rare disease characterized by progressive disappearance of the subcutaneous fat of the upper part of the body. Accompanying abnormalities of carbohydrate and lipid metabolism, diabetes, nephritis, and low levels of complement are frequent. The most striking clinical features are the extremely hollow cheeks, making the normal facial skeleton rather prominent. Very little has been reported on facial reconstruction in such patients. A 16-year-old girl is presented who was successfully reconstructed after the atrophic process arrested spontaneously. Bilateral dermal fat grafts from the buttocks were used in a one-stage procedure. Nine months later, when no more resorption of fat occurred, some trimming of the grafts was necessary. A good result was achieved.