To the Editor.—I was pleased with the article by Adamson et al1in the MayArchives. The authors pointed out that beveling scalp incisions parallel with the hairshafts improves the scarline. May I point out that in any such scalp procedure, be it facelift, temporal lift, or forehead lift, it is best to make the more superior incision perpendicular to the surface of the scalp, and then bevel the more inferior (or anterior, in the case of forehead lift) incision parallel to the hair shaft. This ensures that some intact follicles are present along the cut margin of the superior flap edge, and that the new hair shafts produced by these follicles will tend to grow through the hairline and help to disguise it.
Seventeen healthy male volunteers received 15 mL of 2% solution (300 mg) of lidocaine hydrochloride every three hours for eight consecutive doses. Modes of administration were as follows: (A) each dose washed throughout the oral cavity, then spit out without swallowing; (B) each dose washed, then swallowed; and (C) each dose swallowed directly. Plasma levels of lidocaine and its two metabolites (monoethylglycinexylidide [MEGX] and glycinexylidide [GX]) were measured during and after the period of dosage. In trial A, levels of all three compounds were very low, in no case exceeding 0.3 microgram/mL. During trial C, the mean peak levels of lidocaine and MEGX, respectively, were 0.5 and 0.6 microgram/mL after the first dose, and 0.8 and 1.3 microgram/mL after the eighth dose. Both compounds were essentially undetectable by 12 hours after the last dose. Levels in trial B were very similar to those in trial C. Thus, recommended topical oral cavity use of 2% lidocaine leads to negligible systemic levels of lidocaine and metabolites. Even when doses are swallowed, systemic levels do not approach a toxic range.
A new rapid strength loss catgut suture material can be used for skin closures in wounds of the face and body. Seventy-six comparisons were made under controlled conditions between the new material and one formerly recommended. The new material was used in 588 other wounds as well. It is concluded that the new material is superior to the other in several important ways.
