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Lasers and electrocautery devices have been applied as an alternative to the scalpel because of better hemostasis and lymphatic sealing. However, previous studies have demonstrated conflicting data regarding the effects of these modalities on the inflammatory response, the first reaction by tissue during wound healing. The purpose of this study is to quantitate inflammatory responses in rat skin following laser, electrocautery, and scalpel injury by measuring T-kininogen (T-KGN), a major acute-phase protein in the rat and its endogenous substrate, cathepsin B, an important inflammatory mediator. Full-thickness wounds (6 cm) were created on the dorsum of Sprague Dawley rats by using a laser, electrocautery, or scalpel. Tissue samples were harvested at 1 hour to 21 days after injury. T-KGN levels were radioimmunoassayed; cathepsin B activity was assayed by using a synthetic substrate Z-Arg-Arg-MCA. Data were analyzed by analysis of variance. T-KGN levels peaked at 3 days for all modalities, although the laser group was statistically (P < or = 0.01) higher at 1, 3, and 7 days after injury. In contrast, cathepsin B activity was significantly (P < or = 0.01) lower at 3 days in the laser group. CO2 laser ablation incites a greater inflammatory response than electrocautery or scalpel injuries. High levels of T-KGN may provide protection from proteolytic damage associated with cathepsins.

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Acroangiodermatitis is an unusual cutaneous sequela of chronic venous insufficiency and congenital vascular malformations of the lower extremities. It typically manifests as purple-colored plaques on the extensor surfaces of the toes of the affected limb. Histologically, it closely resembles Kaposi's sarcoma and had thus been named "pseudo-Kaposi's sarcoma." This is a report of acroangiodermatitis in a patient with Klippel-Trénaunay syndrome.

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Fetuses are surrounded by amniotic fluid rich in nutrients and other factors essential to fetal development and possibly to its scarless wound healing. The purpose of this study was to determine whether amniotic fluid contains factors that regulate activities of major proteases involved in the process of wound healing (e.g., collagenase, hyaluronidase, elastase, and cathepsin B). Human amniotic fluid was assayed in vitro for inhibition or stimulation of the activity of these enzymes. Our results showed that amniotic fluid enhanced collagenase activity at a concentration of 66 micrograms protein (p < 0.01), but inhibited activities of hyaluronidase (132 micrograms protein; p < 0.05), elastase (170 micrograms protein; p < 0.05), and cathepsin B (19 micrograms protein; p < 0.01). This finding suggests that amniotic fluid could have an important role in flawless fetal wound healing by regulating these matrix-degrading enzymes.

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Eight neurologically impaired patients underwent reconstruction of chronic perineal and ischial pressure sores utilizing an inferiorly based rectus abdominis myocutaneous flap. Other local and regional flap options had been previously used or were not feasible. In six patients, healing was uncomplicated. One patient required local debridement and flap readvancement. The second involved minor separation of a suture line and healed by secondary intention. All donor sites were closed directly and healed by primary intention. There was no evidence of hernia formation, and no functional deficit was detected from removal of the rectus muscle in any of the patients. In conclusion, it was felt that the inferiorly based rectus abdominis myocutaneous flap should be considered a reconstructive option in dealing with perineal and ischial pressure sores. Furthermore, for reasons discussed, we found distinct advantages to using this flap in spinal cord injury patients.

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Breast augmentation remains a popular aesthetic procedure. Even with the current negative publicity, breast augmentation continues to be a widely accepted procedure. The materials that make up the breast implants have been in use for over 20 years with only minimal complications. Scar contractures continue to be the major complication with this surgery. A causal relationship between silicone breast implants, neoplasms of the breasts, or autoimmune diseases have not been demonstrated in experimental studies on humans. Scientific data presented to the FDA will determine if silicone-containing products will continue to be used for implantation. There is enough concern among some physicians and patients that many are now turning to saline implants. Some of the patients do not entertain the idea of saline implants because of the incidence of deflation and reoperation. Silicone may not be the perfect implantable substance, but no other material has been manufactured to replace this implant in the last 20 years. Until a better material is produced, silicone is the breast implant of choice.

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This article describes the most common options available for reconstruction of the foot. The foot is considered a group of different regions, and it is helpful to classify it into four different anatomic and functional areas. The planning and final outcome of the reconstruction are based on the type of flap available for a specific defect in one of these four territories.

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Infection after augmentation mammoplasty is not common, with the reported incidence between 1% and 7%. The use of prophylactic antibiotics, however, is widespread in plastic surgery: It was documented in a 1975 survey in which 43% of responding plastic surgeons used prophylactic antibiotics. Fifteen years since this survey, surgeons have witnessed an explosion in antibiotic variety and have participated in their increased use. For many procedures, the use of antibacterials has evolved by convention and personal preference, based often on only anecdotal information. This report is our study of the routine use of antibiotics to prevent wound infection after augmentation mammoplasty.

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A series of 148 patients who underwent reduction mammaplasty utilizing the superomedial pedicle technique is presented. Resections as large as 4100 gm per breast with nipple-areola transpositions up to 30 cm were done with reliable nipple-areola survival, including preservation of sensation. The superior pedicle technique of breast reduction is recognized by many as technically easier and capable of producing a longer-lasting aesthetic effect. Classically, however, it has been limited to smaller resections. By incorporating the medial quadrant in the superior pedicle, more aggressive reductions can be safely undertaken with the same excellent results. Details of the procedure, the anatomic basis for its success, and complications are discussed.

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Large abdominal wall defects (ventral hernias) can be difficult to repair. Some defects are not amenable to primary repair or the use of synthetic mesh because of repeated recurrence or wound infection. In complicated situations such as that mentioned above, the extended latissimus dorsi muscle flap has been used to repair upper and middle abdominal wall defects. This method has been utilized in six patients, and there has been no recurrence of the defect or evidence of a lumbar hernia. The follow-up has been from 7 to 66 months. The extended latissimus dorsi muscle flap has proven to be an excellent alternative in the repair of complicated abdominal wall defects.

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A study of 156 patients who underwent augmentation mammoplasty at the Medical College of Georgia from June 1980 to July 1985 is presented. Complete records on 89 patients with 196 implants were obtained. A retrospective analysis with respect to capsular contracture was undertaken. Possible influential variables including age of patient, type of prosthesis, operative blood loss, use of local steroids, and site of insertion (i.e., submuscular versus subglandular) were considered. The site of implant insertion was the only statistically significant factor affecting capsular contracture. The incidence of capsular contracture was 9.4% with the submuscular approach and 58.0% with subglandular contracture. The followup time for the submuscular group was 17.4 months (range of 6-36 months) with the mean time of capsule contracture occurring 4.5 months after insertion. There were no significant differences in intraoperative blood loss or elapsed operating time between the submuscular and the subglandular placements of the prosthesis. This study confirms the submuscular technique of augmentation mammoplasty as the most reliable method of reducing the high incidence of capsular contracture.

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A case of a large central neurofibroma of the left posterior maxilla is presented. This lesion was treated by a left radical maxillectomy because of the extensive nature of the tumor. The surgical defect was reconstructed with a latissimus dorsi myocutaneous flap. The incidence and clinical features of intraosseous benign nerve sheath tumors are discussed.

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The anatomy and technique of applying the pedicled latissimus dorsi myocutaneous flap to head and neck defects and three cases illustrating this application are presented. Additional points of interest, further experience with the flap, and some pitfalls are discussed.

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Forty-six patients with ulnar artery thrombosis were evaluated. A comparison of the results was made between those patients who were treated by sympathectomy and those in whom we attempted to reestablish the blood flow. A reverse vein graft was often used in the latter group. Based on the results of this study, we believe the preferred method of treatment for ulnar artery thrombosis is an attempt at the reestablishment of blood flow.

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We have done subpectoral augmentations on 100 women to enlarge the small or hypomastic breast to a pleasing degree. These operations were performed in a major hospital operating room, under local anesthesia, on an ambulatory basis. No complications were encountered. Our goal, and that of our patients, was to enlarge the small breast to a pleasing degree which would harmonize with the body contour and form, and to maintain the natural consistency of the breast and the normal sensation of the nipple and the breast as a whole. This goal was reached and our patients have been appreciative and pleaded. There was no postoperative weakness of the pectoralis muscle, and we have seen no evidence of capsule contracture. The group represents about one percent of our overall experience with augmentation mammaplasty.

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