Sideburn reconstruction with an arterial V-Y hair-bearing scalp flap after the excision of basal cell carcinoma

A new flap is presented for sideburn reconstruction. It has good vascularity and hair direction. There is some tension in the closure of the scalp donor site that can be associated with alopecia. The flap should be advanced only to the desired sideburn level, with a cervicofacial flap covering any remaining defect. Follow-up at 2 years 4 months confirmed the satisfactory result. This flap adds another option to those discussed in this article for sideburn reconstruction.     

A review of scalp split-thickness skin grafts and potential complications

A review of 113 patients who underwent 178 scalp split-thickness skin graft procedures is presented. Although our study confirms some of the work of previous authors, we found that the scalp donor site has potential complications which should be considered. These complications are minor in the adult population. In the pediatric population, however, excessive blood loss due to the relatively large surface area of the scalp limits the use of the scalp as a preferred donor site.     

Use of human amnion for microvascular interpositional grafts

A major problem associated with vascular grafting employing an artificial graft is the inflammatory response provoked by the graft and subsequent complications of classical acute rejection phenomena when the graft is implanted subcutaneously into human volunteers. The favorable results obtained by a preliminary study of subcutaneous implantation of amnion in our laboratory have led us to a prospective study to determine its value as a vascular graft. Tubed conduits of glutaraldehyde-treated amnion were hand constructed of varying diameters and lengths. They were employed as segmental interpositional grafts in experimentally created femoral and aortic arterial defects in Sprague-Dawley rats. Patency rates varied from 60 to 90 percent, with all grafts showing remarkable reendothelialization within 3 to 4 weeks postoperatively. Morphology, antigenic reaction, blood flow, and patency of the different experimental amnion grafts were evaluated and compared to appropriate controls.     

Use of rotation scalp flaps for treatment of occipital baldness

We have used 25 rotation scalp flaps to treat occipital baldness associated with fronto-parietal baldness (the third flap), and 35 such flaps for the correction of isolated occipital baldness. We have not had any flap necrosis, and our patients have been well satisfied with the results of this surgery.     

A comparison of hole punch and needle punch methods for the measurement of seagrass productivity

Seagrass productivity, as leaf extension, was measured using the hole punch and needle punch techniques. These methods have been widely implemented to determine seagrass leaf extension rates, yet there is no evidence in the literature of a comparison between methods. The hole punch method involves removing part of the basal area of a seagrass leaf and it was proposed that this measurement technique may affect the leaf extension rates that are being measured. Leaf extension rates were measured in Posidonia sinuosa meadows off the coast of Perth, Western Australia. There were no significant differences in seagrass leaf extension between the two methods. The hole punch method is favoured, as measurement of incremental leaf growth is facilitated by the obvious hole left by the punch. The needle punch method leaves lesions on seagrass leaves that are easily confused with other lesions, possibly left by invertebrate grazers. These findings are likely to be applicable to other straplike seagrass species, though a similar comparison is recommended in the initial stages of a study.     

Allogeneic neonatal neuronal retina grafts display partial immune privilege in the subcapsular space of the kidney

Transplantation of immature retinal tissues may offer a solution for restoring sight to individuals afflicted with degenerative retinal diseases. Promising results have recently demonstrated that neonatal retinal grafts placed in the eye can survive, differentiate into photoreceptor cells, and respond to evoked electrical stimuli. These transplants, however, were performed in immunologically immature recipients. Since it is important to know whether neonatal neuronal retina (NNR) tissue is immunogenic in immune-competent recipients, and whether this tissue displays inherent immune privilege, we have examined the fate of such grafts placed in a non-immune-privileged site of adult recipient mice. We found that typical, photoreceptor-dominated rosettes formed in differentiating NNR grafts, and that these allografts survived beyond 12 days, whereas genetically identical skin grafts were rejected earlier. Class II MHC-bearing cells of recipient origin were observed along the edge of NNR allografts as early as day 5. Donor-specific delayed hypersensitivity was not detected at 12 days, but did emerge on day 20, coincident with rejection of NNR allografts. Lymph nodes, but not spleens, of mice bearing NNR grafts at 12 days contained regulatory lymphoid cells that suppressed delayed hypersensitivity in naive recipients. We conclude that NNR grafts accommodate and even differentiate in the non-immune-privileged space beneath the kidney capsule. Survival beneath the kidney capsule of NNR allografts, but not skin allografts, at 12 days and beyond implies that NNR tissue possesses inherent immune privilege. The vulnerability of these grafts to rejection by 20 days reveals this privilege to be partial and temporary.     

Use of acyclovir in the prevention of herpes infections after allogenic bone marrow grafts

In a double-bind controlled study, oral Acyclovir has been compared to a placebo in a series of 39 consecutive patients undergoing bone marrow transplantation. A dose of 200 mg was given every 6 h from day 8 to day 35 after transplantation. Pharmacokinetic studies have shown the good absorption of the drug despite intestinal damage related to chemoradiotherapy or gut graft-versus-host disease (GVHD), there was no sign of toxicity. The protection against herpes simplex virus (HSV) infection was complete in the treated group when compared to the control group even in patients with high anti-HSV antibody titres. The same protection was observed against cytomegalovirus (CMV) infection. The incidence of HSV and CMV was the same in both groups after treatment ended. This study confirms the efficacy of Acyclovir against HSV infection and possibly against CMV infection when it is given prophylactically after bone marrow transplantation.     

Use of dermal grafts to cover implants in breast reconstructions.

The use of dermal grafts for the reinforcement of the cover over implants in breast reconstructions after radical mastectomy is illustrated in several cases. By carefully selecting the patients, we feel that this relatively minor procedure may replace the use of local of distant flaps in a good many breast reconstructions.     

Detection of complete and partial chromosome gains and losses by comparative genomic in situ hybridization

Comparative genomic in situ hybridization (CGH) provides a new possibility for searching genomes for imbalanced genetic material. Labeled genomic test DNA, prepared from clinical or tumor specimens, is mixed with differently labeled control DNA prepared from cells with normal chromosome complements. The mixed probe is used for chromosomal in situ suppression (CISS) hybridization to normal metaphase spreads (CGH-metaphase spreads). Hybridized test and control DNA sequences are detected via different fluorochromes, e.g., fluorescein isothiocyanate (FITC) and tetraethylrhodamine isothiocyanate (TRITC). The ratios of FITC/TRITC fluorescence intensities for each chromosome or chromosome segment should then reflect its relative copy number in the test genome compared with the control genome, e.g., 0.5 for monosomies, 1 for disomies, 1.5 for trisomies, etc. Initially, model experiments were designed to test the accuracy of fluorescence ratio measurements on single chromosomes. DNAs from up to five human chromosome-specific plasmid libraries were labeled with biotin and digoxigenin in different hapten proportions. Probe mixtures were used for CISS hybridization to normal human metaphase spreads and detected with FITC and TRITC. An epifluorescence microscope equipped with a cooled charge coupled device (CCD) camera was used for image acquisition. Procedures for fluorescence ratio measurements were developed on the basis of commercial image analysis software. For hapten ratios 4/1, 1/1 and 1/4, fluorescence ratio values measured for individual chromosomes could be used as a single reliable parameter for chromosome identification. Our findings indicate (1) a tight correlation of fluorescence ratio values with hapten ratios, and (2) the potential of fluorescence ratio measurements for multiple color chromosome painting. Subsequently, genomic test DNAs, prepared from a patient with Down syndrome, from blood of a patient with Tcell prolymphocytic leukemia, and from cultured cells of a renal papillary carcinoma cell line, were applied in CGH experiments. As expected, significant differences in the fluorescence ratios could be measured for chromosome types present in different copy numbers in these test genomes, including a trisomy of chromosome 21, the smallest autosome of the human complement. In addition, chromosome material involved in partial gains and losses of the different tumors could be mapped to their normal chromosome counterparts in CGH-metaphase spreads. An alternative and simpler evaluation procedure based on visual inspection of CCD images of CGH-metaphase spreads also yielded consistent results from several independent observers. Pitfalls, methodological improvements, and potential applications of CGH analyses are discussed.