Abstract:

Replantation of fingers, hands, feet, and extremities has become a relatively common procedure. There are a number of reports of successful replants of facial parts. Since the feeding vessels are extremely small, these replants are most challenging. Venous outflow is the most common problem, and leeches and anticoagulants are commonly needed, resulting in considerable blood loss and transfusions. Nonetheless, the successful replantation of a facial part yields an aesthetic and functional result far superior to any other reconstructive option. We review our experience with 7 scalps, 4 ears, and 2 lips.

Authors:

Gabriel M. Kind, M.D., Harry J. Buncke, M.D., F.A.C.S., Gregory M. Buncke, M.D., F.A.C.S., Jonathan S. Schreiber, M.D., Peter Siko, M.D., Davies Medical Center, San Francisco, CA; Tertius H.J. Venter, M.B., Ch.B., F.C.S.(S.A.), M.Med., Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa

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Abstract:

The surgical treatment of breast cancer has changed dramatically in the last 30 years. The era of the Halsted radical mastectomy has passed, and less deforming surgeries have come into use. Partial mastectomy in association with axillary lymph node dissection has become a viable alternative for stage 1 and 2 carcinomas; more advanced tumors may be treated with breast conservative surgery when neoadjuvant chemotherapy is utilized. Further, the use of mammography in screening for breast cancer has led to an increase in the diagnosis of ductal carcinoma in situ (DCIS), another lesion for which breast conservation is often indicated.

Authors:

George H. Rudkin, M.D., UCLA Medical Center, Los Angeles, CA; Susan M. Love, M.D., Revlon/UCLA Breast Center, UCLA Medical Center, Los Angeles, CA

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Abstract:

Alopecia-reducing procedures were first introduced to the field of cosmetic hair restoration surgery in 1977 and have advanced to the point that large areas of baldness can be treated very effectively and expeditiously. The most aggressive of the alopecia-reducing procedures is called scalp-lifting (undermining down to the hairline of the nape) and consists of the lateral lift, the bilateral occipitoparietal lift , and the bitemporal lift . These procedures are usually used to correct posterior baldness while hair grafts are used for frontal hairline restoration. Although incredible results can occur with this methodology, it is not without its difficulties. One of the most formidable of these problems is slot formation with divergent hair direction. This problem can develop after multiple alopeciareducing procedures are carried through. In an excellent study performed by Nordstrom in 1983, he demonstrated that the total length of the bald area increases by approximately 10% of its total length with each progressive operation. This increased length in the posterior region can cause a severe cosmetic deformity, especially in patients who are extensively bald and have had several of these procedures.

Authors:

Dominic A. Brandy, M.D., F.A.C.S., University of Pittsburgh Medical Center, Pittsburgh, PA

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