It is often hard to be critical of a book written in good faith and with every good intention by surgeons invited from different parts of the world, by a single editor himself with a strong reputation as an international speaker.I have to say, though, that this book, Clinics in Plastic Surgery: Necklift, edited by Malcolm D. Paul, is not one to get too excited about.It is not actually exclusively about lifting the neck: it is about methods to nonsurgically tighten the superficial skin and to surgically rejuvenate the aging neck but mostly at a level above the hyoid only.At first glance, the book is disappointingly small in size but not small enough to put in a pocket.It is rather unattractively color mismatched and could be easily lost behind a cupboard or under a short table leg.It is a thin book, deficient in pages, sometimes with blank sheets, yet it is supposed to contain substance and exciting tips and tricks from all of its 16 invited authors (presumably with major contributions from some junior doctor coauthors).It is not set out in chapters per se, and this adds to the somewhat difficult-tofollow and confused lack of flow to the book.It is really a collection of anecdotes and personal preferences.Some authors clearly understand what we, as readers, want to know.Others, unfortunately, say very little of interest and stick to some pre-thought-out questions presented by the editor.I will expand upon these later.On balance, I think this book may be useful to some young plastic surgeons engaging in the concept of facial aesthetic surgery and perhaps as guidance to those wanting ideas to improve their current outcomes.There are apparently some good

Background: Yannas and Burke developed the concept of the dermal regeneration template in the 1970s. It is now a widely accepted tool in the treatment of burns as well as in reconstructive surgery. Methods: The authors present a previously published study of Integra used in 20 consecutive patients to reconstruct 30 anatomical sites and then analyze the histologic and clinical outcomes. Wound healing was evaluated by examination of weekly punch biopsy specimens with standard and immunohistochemical stains. Patient satisfaction was assessed using a visual analogue scale, and scar appearance was assessed using a modified Vancouver Scar Scale. Results: Four distinct phases of dermal regeneration could be demonstrated histologically: imbibition, fibroblast migration, neovascularization, and remodeling and maturation. Full vascularization of the neodermis occurred at 4 weeks. Patients reported increased range of movement and improvement in appearance compared with their preoperative states. Conclusions: The color of the matrix reflected the stage of neodermal vascularization. No adnexa, nerve endings, or elastic fibers were seen in any of the specimens. The new collagen was histologically indistinguishable from normal dermal collagen. The authors also present their current protocol and experience with using Integra for a range of reconstructive procedures.

We report a head and neck full-thickness burn injury that was reconstructed with a tissue-engineered dermal template and then early implantation of microdissected hair follicles through the silicone epidermis 12 days after the burn injury. The treatment resulted in complete reepithelialization and a hair-bearing scalp without the need for a split-thickness skin graft. Restoration of the stem cell population, hair growth, and earlier reepithelialization were achieved using this novel micrografting technique, and histologic examination confirmed maturation of a normal skin type over the subsequent 2 years.

BJU InternationalVolume 92, Issue s3 p. e14-e14 Penile paraffinoma and a novel treatment N. CHOUDHURY, N. CHOUDHURY Department of Urology andSearch for more papers by this authorJ.D. FRAME, J.D. FRAME Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, UKSearch for more papers by this authorH.J.E LEWI, H.J.E LEWI Department of Urology andSearch for more papers by this author N. CHOUDHURY, N. CHOUDHURY Department of Urology andSearch for more papers by this authorJ.D. FRAME, J.D. FRAME Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, UKSearch for more papers by this authorH.J.E LEWI, H.J.E LEWI Department of Urology andSearch for more papers by this author First published: 07 December 2007 https://doi.org/10.1111/j.1464-410X.2003.02940.xCitations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume92, Issues3December 2003Pages e14-e14 RelatedInformation

Despite the recent improvements in cell culture and dermal regeneration methods, tissue engineering of skin has yet to receive widespread acceptance in the management of burn injuries. The reasons for this are complex and include not only the inherent costs of (particularly) setting up and running such a system but also the continuing difficulties in achieving successful engraftment of the neoepidermis. The latter has previously been addressed in a number of ways, including improving the recipient bed and using pre-confluent delivery systems to allow earlier application of cells to that wound bed. One area that has received little attention is that of the optimal wound dressing to use with this technology; the cells are very poorly attached at early time points, and, in this context, the traditional dressing of paraffin gauze has never been formally assessed in comparison with newer materials. Using a porcine acute wound chamber model, we performed a prospective randomised trial to assess four different wound dressings with reference to the amount of epidermal cover gained and the histological quality of the regenerated skin after 3 weeks. Out of the four materials tested, polyurethane foam (Allevyn) was superior histologically (although equal in take rate with paraffin gauze), whilst polythene sheet (Opsite) and silicone sheet were substantially inferior. We conclude that the traditional dressing used with this technology should be compared with polyurethane foam in a clinical trial. In the future, novel dressings should be formally tested against traditional methods before being adopted.

The treatment of extensive burn injuries has been enhanced by the development of artificial skin substitutes. Integra Artificial Skin, an acellular collagen-glycosaminoglycan (C-GAG) dermal equivalent requires a two-stage grafting procedure. However, preseeding the C-GAG dermal equivalent with cultured fibroblasts and keratinocytes, with the aim of performing a single-stage grafting procedure, may be beneficial in terms of replacing the requirement for traditional split-skin grafts. In this comparative in vitro study, the interactions of cultured human dermal fibroblasts and epidermal keratinocytes in Integra Artificial Skin in comparison to cadaver deepidermalized dermis (DED) was investigated. An increase in cell proliferation and migration in the C-GAG dermal equivalent was observed over time. Cocultures of fibroblasts and keratinocytes on both dermal equivalents showed positive expression of proliferation, differentiation, and extracellular matrix (ECM) protein markers. Organization of keratinocytes in the epidermal layers of DED composites were better compared to the C-GAG composites. Deposition of ECM proteins was enhanced in the presence of keratinocytes in both dermal equivalents. Results demonstrate that in vitro the C-GAG dermal equivalent is biocompatible for cell attachment, migration, proliferation, and differentiation. Preseeding Integra Artificial Skin with cultured autologous fibroblasts and keratinocytes for in vivo application, as a single-stage grafting procedure, warrants testing. A better clinical outcome may be achieved as shown by our in vitro results of the coculture composites.

Integra artificial skin was introduced in 1981 and its use in acute surgical management of burns is well established, but Integra has also been used in patients undergoing reconstructive surgery. Over a period of 25 months, the authors used Integra to cover 30 anatomic sites in 20 consecutive patients requiring reconstructive surgery and then analyzed the clinical and histologic outcomes. The most common reason for surgery was release of contracture followed by resurfacing of tight or painful scars. The authors assessed patients' satisfaction using a visual analog scale and scar appearance using a modified Vancouver Burn Index Scale. They evaluated the progress of wound healing by examining weekly punch-biopsy specimens with standard and immunohistochemical stains. Patients reported a 72 percent increase in range of movement, a 62 percent improvement in softness, and a 59 percent improvement in appearance compared with their preoperative states. Pruritus and dryness were the main complaints, and neither was improved much. Four distinct phases of dermal regeneration could be demonstrated histologically: imbibition, fibroblast migration, neovascularization, and remodeling and maturation. Full vascularization of the neodermis occurred at 4 weeks. The color of the wound reflected the state of neodermal vascularization. No adnexa, nerve endings, or elastic fibers were seen in any of the specimens. The new collagen was histologically indistinguishable from normal dermal collagen. The authors conclude that Integra is a useful tool in reconstructive surgery. The additional cost of its use can be justified by its distinct benefits compared with current methodology.

Koebner's phenomenon is an uncommon postburn complication. The following report describes a female child who sustained an 80% total body surface area scald which healed with conservative treatment. She developed a cutaneous Aspergillus infection involving only the previously scalded areas. The uninjured skin remained normal. She went on to develop systemic aspergillosis and died of multi-organ failure.

Eighteen cases of turret exostoses of the hand have been reported, all associated with dorsal injuries. We present a case of turret exostosis involving the volar aspect of the thumb.

Pyoderma gangrenosum is an unusual cause of skin necrosis following surgery, particularly in those without an associated systemic condition. There have been reports of the condition in this context but not in relation to breast reconstruction. We present a case of pyoderma gangrenosum following latissimus dorsi flap reconstruction of a breast.

Toxic shock syndrome is associated with burn injuries in children and is a cause of significant morbidity in this group. Despite multiple cases of toxic shock syndrome in adults being reported since its original description it has not been reported in adult burn patients. We report a case of toxic shock syndrome in an adult following 25% flame burns.

Clinical assessment of burns is accurate for very deep and very shallow burns, but it has been suggested that there is a high degree of inaccuracy in the assessment of dermal burns. Histologic analysis has, by some, been considered too time-consuming for routine diagnosis. It also requires an expert skin histopathologist to categorize the depth. With the use of an in vitro model, we have found the use of cryosections and an immunofluorescent staining method to be quicker and more clear-cut than standard light microscopic techniques. We believe this method plays a role in helping to define burns that would benefit from early excision and grafting. However, further investigation is required to transform the method from an experimental model to standard practice in the clinical setting.

In this article, we present our experience of group lightning injury. Individual injuries are most common after single strikes. The largest group previously reported was 10 patients. In our series, 17 victims were hit by a single strike; 11 were admitted to the hospital and 6 were discharged from the accident and emergency department. Although injured under the same circumstances, these patients presented with a wide range of symptoms and signs. We also describe a characteristic burn pattern, the "tip-toe sign."

Over the last decade, suction-assisted lipoplasty has been shown to be a safe and reliable procedure in the hands of trained individuals. A large number of plastic surgeons employ liposuction as an adjunct to surgery for gynecomastia with excellent results and low morbidity. An unusual problem, traumatic rupture of the pectoralis major muscle, has been observed by us in a patient who had undergone the procedure. The physical deficit arising from the injury may go unnoticed in all but the most physically active people, and surgeons should be wary of the possibility of this previously unreported complication.

Silicone breast implants have been used for augmentation mammoplasty for cosmetic purposes as well as for breast reconstruction following mastectomy for more than three decades.Though the use of the silicone gel filled variety has been banned in the USA except for special cases, they continue to be available elsewhere in the world including the UK.Despite the immense benefit they provide, their usage is associated with some complications.Most of these are related to the surgery and can be reduced by good surgical management.The major complications associated with their use is adverse capsular contracture, an outcome which can be very frustrating to manage.This article reviews the commonly reported complications and suggested management alternatives.

The combined use of cynthaskin, as an occlusive and hydrating agent, and triamcinolone acetonide, incorporated as a topical steroid, was investigated in a prospective study in the treatment of hypertrophic scars and keloids. The product is a lotion which dries up to form an adherent and transparent film, a property that offers unique advantage in the treatment of scars and keloids on the face and other exposed parts of the body. Forty-one patients were studied: 32 with hypertrophic scars (group A) and 9 patients with keloids (group B). In group A, 84.4% of the patients improved after treatment, compared to 44.4% in group B. The difference in response to treatment between the two groups is significant (p=0.03). However, all patients in both groups achieved symptomatic relief of itch and pain.