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This study was undertaken to evaluate smile satisfaction among Israeli young males, to develop norms for young Israeli adults' smile parameters, and to determine whether there is a relationship between these parameters and par-ticipants' ethnic origin. The study population consisted of 403 Israeli young male adults. Participants were asked to report their ethnic origin, past orthodontic treatment and to grade their overall satisfaction from their own smile on a numerical scale of from 1 to 5. Smile parameter measurements were taken and the data analyzed. We concluded that there may be a common Jewish/Israeli norm of smile parameters. Consideration of the criteria of a smile obtained from this study may be useful in improving the esthetic value of prosthetic, restorative and orthodontic treatments.

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BACKGROUND: Improvements in burn care during the last two decades call for new prediction models of morbidity and mortality. The aim of the study was to identify parameters that are predictive of major morbidity factors and risk of mortality in patients with burn injury. METHODS: The charts of 249 patients (236 survivors) aged 1 to 94 years who were treated for second- and third-degree burns from 1995 to 2002 were reviewed. A multivariate linear stepwise regression model was fitted to the data to predict length of hospitalization, length of operations, and mortality rate. RESULTS: Survivors' mean burn size was 14 +/- 15 percent of the total body surface area (range, 5 to 90 percent), with a mean hospitalization time of 22.9 +/- 17.1 days and a mean operative time of 127.5 +/- 166.8 minutes. The prognostic factors in each of the regression models predicted 40 percent and 55 percent of the variance in length of hospital stay and operative time, respectively. Total body surface area alone explained most of the variance (29 percent and 44 percent, respectively). As a result, the authors created shorter formulas: Length of hospitalization (days) = 18 + [total body surface area]/3; Operative time (minutes) = 55 + 4[total body surface area]. Total body surface area and smoke inhalation were the only statistically significant predictors of death. Every 1 percent increase in total body surface area was associated with a 6 percent increase in mortality risk. The presence of smoke inhalation increased mortality risk by nine-fold. CONCLUSIONS: Using objective measurements in burn treatment is of great importance. The formulas presented by the authors explain a considerable percentage of the probability of morbidity in burn victims. The authors suggest that other burn units develop their own statistically supported prediction models.

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Most of the techniques that have been suggested for closure of sacral pressure sores use musculo-cutaneous flaps. We report our experience in three patients using the SpaceMaker balloon dissector. The dissector was inserted into the subgluteal maximus muscle plane to expand the muscle and overlying skin, thereby forming bilateral sliding and tension-free musculocutaneous flaps. The procedure is simple, safe, bloodless, and combines the advantages of advancement of a muscle flap and expansion.

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The pectoralis major advancement flap is currently the most popular technique for reconstruction of the anterior chest in patients with sternotomy wounds. Recently, the SpaceMaker balloon was introduced for rapid expansion of the pectoralis major muscle intraoperatively. The aim of the present study was to investigate the biomechanical and histologic effects of this expansion technique in a rat model. The upper 2 cm of the sternum was resected in 54 male rats. Reconstruction with balloon-assisted pectoralis muscle expansion was performed in 24 rats (study group). Another 24 rats underwent reconstruction with simple muscle advancement without expansion. Submuscular insertion of a catheter for expansion, without inflation, was performed in the remaining six rats (sham group). Rats were killed either immediately or 2 to 4 weeks after surgery. Thirty-eight rats, including 16 after reconstruction with expansion, 16 after reconstruction without expansion, and six in the sham group, were killed immediately after surgery. Sixteen rats were killed 2 to 4 weeks after surgery, eight rats for each reconstruction technique. Before the animals were killed, the biomechanical properties of the muscles were tested with weights to calculate stiffness (in newtons per meter) and compliance gain (in percent). After the animals were killed, biopsy specimens were obtained for histologic analysis. Results indicated significantly lower muscle stiffness in the study group compared with the others immediately after surgery (p = 0.0000), although the difference failed to achieve statistical significance 2 to 4 weeks later (p = 0.76). In the study group, the compliance gain was 74.4 percent immediately after surgery but only 3.4 percent 2 weeks to 1 month postoperatively. Histologic examinations in all groups immediately and 2 to 4 weeks after surgery revealed regular muscle striation with no signs of inflammation. The elastic stiffness of the rat pectoralis major muscle is significantly reduced following rapid intraoperative expansion and returns to normal 2 to 4 weeks later.

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Studies of breast volume and size have failed to take into account the aesthetic value of the nipple-areola-breast proportion. These data are important to plastic surgeons in planning breast reduction, augmentation, and reconstruction. In the current study, the anatomic size of the nipple, areola, and breast was measured in 37 women aged 20 to 64 years, and their proportions were calculated. The areola-breast and nipple-areola proportions were 1:3.4 and 1:3, respectively. The natural nipple-areola-breast proportion is approximately 1:3. This study provides a general guideline for plastic surgeons for planning breast surgery with optimal aesthetic results.

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Prevention of hernia or bulge of the abdominal wall after TRAM breast reconstruction has been a challenge for the reconstruction surgeon. Different techniques have been described to avoid this complication. The use of anterior rectus abdominis sheath (ARAS) for the repair of various abdominal wall hernias has been well described in the literature and is the basis of the authors' technique. The authors present the use of ARAS flap in TRAM breast reconstruction. It is a simple and safe technique using autologous tissues for hernia or bulge prevention.

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The incidence of cutaneous malignant melanoma is increasing constantly. The most accurate prognostic factor of primary melanoma is thickness of the lesion according to Breslow. Information and screening campaigns for early diagnosis of melanoma are based on the assumption that tumor thickness is the consequence of a delay in diagnosis. However, the correlation of delay in diagnosis with prognosis remains controversial. In this report, the authors investigated the role of the physician and the patients in diagnostic delay in melanoma and areas in which improvement is needed. The reduction of the time to diagnosis in specific population groups may improve the prognosis of melanoma.

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Nitric oxide (NO) was first recognized as the endothelial-derived relaxing factor in 1987, and since then has been extensively studied. It was found to be involved in almost every physiologic or pathophysiologic process in human biology. This study examined the correlation between peripheral blood levels of NO and the microvascular anastomotic patency of an infrarenal aortic anastomosis in a rat model. Four groups of six Sprague-Dawley rats each were studied. Three groups underwent microsurgical manipulation which included: anastomosis followed by ligation of the aorta in one group; anastomosis of the aorta in another; and dissection of the infrarenal aorta in the third group. A fourth group served as controls. Peripheral blood samples for NO levels were taken at different times before and during the first 24 hr after surgery. Results demonstrated a transient rise of NO levels in all operated groups. The ligated group exhibited the most prominent rise in NO blood levels. This rise was statistically significant, compared to the rise in other groups during the first 6 hr postoperatively. The anastomosed group levels were only mildly higher than the dissected group, showing no statistically significant difference postoperatively. NO blood levels in all of the groups returned to baseline at 24 hr postoperatively. The study shows that changes in NO levels in peripheral blood are detectable after microsurgical manipulation of the infrarenal aorta in a rat model. Furthermore, in rats undergoing ligation of the anastomosed aorta, mimicking anastomotic occlusion, NO peripheral blood levels are significantly higher than when the anastomosis remains patent.

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Hypertrophic scars cause great discomfort to the patient and pose a challenge for the reconstructive surgeon. This is particularly true in the facial area. Optimal function and aesthetic appearance are the main goals of reconstruction. We suggest an adjunct to the surgical management of facial hypertrophic scars which involves abrasion of the subdermal plane. The technique consists of removal of all scarred skin from the aesthetic unit, dermabrasion of subcutaneous tissues, including the muscular surface (subdermabrasion), and a full thickness skin grafting. This technique was applied in a young patient with hypertrophic burn scars of the chin. Biopsy confirmed our basic assumption that hypertrophic scars extend into the muscular plane.

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