Collagen in wound healing

248

Injury: the British Journal

BAUR P. S., LARSOND. L. and STACEY T. R. (1975) The observation of myofibroblasts in hypertrophic scars. Surg. Gynecol. Obstet. 141, 22. Failures

in metallic

implants

An analysis of all the implants removed over a 2-year period. Reasons for removal included infection (early and late), breakage, technical failure and loosening. Some were removed as a routine. We are not told the total number of implantations so that it is impossible to deduce the successful percentage. Corrosion was observed in some of the removed metalware. WEINSTEIN A., A~TUTZ H., PAVON G. and FRANCESCHINIV. (1973) Orthopaedic implants-a clinical and metallurgical analysis. J. Biomed. Muter. Res. Symposium No. 4, 297. Collagen

in wound

healing

An experimental study of skin incisions in pigs. The orientation of cells and fibres during healing follows the axis of the wound rather than that of pre-existing collagen, suggesting that orientation might be due to a chemotactic influence of the traumatized area rather than to mechanical factors or to pre-existing structural arrangements. LAUFERM., ASHKENAZ~C., KATZ D. and WOLMAN M. (1974) Orientation of collagen in wound healing. Br. J. Exp. Pathol.

55, 233.

Plastics Free-flap

transfers

The case reports so far published of free-flap transfers by microvascular anastomosis have all stressed that end-to-end suture of the vessels is the technique of choice. However, end-to-side suture of the arteries would greatly extend the choice of vessels to which the flap could be anastomosed and this paper reports 5 successful examples of this technique. IKUTA Y., WATARI S., KAWAMURAK., SHIMA R., MATSUISHIY., MIYOSHIK. and TSUGEK. (1975) Freeflap transfers. Br. J. Plast. Surg. 28, 1. Free vascularized

bone grafts

This beautifully illustrated and well-documented paper presents two patients in whom extensive bone and soft-tissue loss in the leg was restored by composite free vascularized bone grafts from the opposite fibula, joined by microvascular anastomosis at the recipient site. Quite apart from its application in the salvage of some badly damaged limbs, this technique offers exciting possibilities in the treatment of certain congenital lesions, for example, congenital absence of the radius. TAYLORI. G., MILLER G. D. H. and HAM F. J. (1975) The free vascularized bone graft. Plust. Reconstr. Surg. 55, 533. Free groin

flaps

in children

In their earlier papers, these Japanese workers reported the successful transfer of large free skin flaps

of Accident

Surgery

Vol. ~/NO. 3

by microvascular anastomosis in healthy adults. This paper describes the use of the same technique in two children under the age of 5. In one child, the transfer was carried out at the time of the primary surgical treatment of the wound, in the other, as a delayed reconstructive procedure, one year later. In the latter child the result is quite outstanding. HARII K. and OHMORIK. (1975) Free groin flaps in children. Plust. Reconstr. Surg. 55, 588. Scalping

injury

A review article of the history of scalping accidents with a useful list of references. One case is reported in which the attempted resuture of a very large avulsed flap failed. After excision of the dead tissue and repeated dressings with amniotic membrane the granulating area was covered with a split-skin graft measuring about 200 in2. Koss N., ROB~~N M. C. and KRIZEK T. J. (1975) Scalping injury. Plast. Reconstr. Surg. 55, 439. Autotransplant

of omentum

A 5-year-old girl presented 7 months after a scalping injury with extensive areas of bare bone and granulating tissue. The defect was covered by an omental transplant anastomosed to the right superficial temporal artery and vein and this, in turn, was covered by a sheet of split skin. Three months later the graft was soft and supple, with an adequate subcutaneous cushion of tissue. The writer quotes two earlier papers in which a similar technique was used (MCLEAN D. and BUNCKE H. J. (1972) Plust. Reconstr. Surg. 49, 268. HARI~ K. and OHMORI S. (1973) Plust. Reconstr.

Surg. 52, 541.)

IKUTA Y. (1975) Autotransplant of omentum to cover large denudation of the scalp. Plast. Reconstr. SW-g. 55, 490.

Multiple Cyclone

injuries Tracy

Darwin had 45,000 persons living in 12,000 homes, of which only 500 escaped serious damage. Forty-nine persons were killed and 16 more were lost at sea; more than 500 persons went to hospital and nearly one-third had to be admitted on the first day. Unlike many disasters that have been reported in the British medical press in recent years, the destructionof thecity of Darwin by a cyclone produced a very small number of casualties in proportion to the damage done and draws attention to the fact that hospitals may lose essential supplies such as power, light and water.

Another important difference is that Darwin is an isolated centre of population, from which some set out to travel 2000 miles to Adelaide. In such circumstances, help must come from afar and Professor Rhodes pays tribute to the way in which the Armed Forces rose to the occasion, providing staff and supplies as well as evacuating casualties and others, and he sets great store by the fact that one man was in supreme command of the rescue operation. Nevertheless, important questions have to be asked: are