488
ABSTRACTS
20 yr and 31-64 years), showed that although gentamicin half lives varied from patient to patient, the half life in the young and old ...
20 yr and 31-64 years), showed that although gentamicin half lives varied from patient to patient, the half life in the young and old patient was significantly different. The authors define adequate serum levels as peak gentamicin concentration of at least 8 mg/ liter in patients with pneumonia or 5 mg/ liter in patients with other primary sources of sepsis. Subtherapeutic levels may be responsible for some of the failures of gentamicin treatment. The authors mention patients with
Pseudomonas ecthyima gangrenosum who survived the course of infection with peak serum gentamicin levels of 9.3-12.1 mg/liter. The daily dosage of gentamicin required was between 16.7-30 mg/kg/day. The higher dosage requirement for the younger group may be related to a more rapid elimination of the drug. Gentamicin half life in children is indicated to be 2.5-3.5 hr. The patient with a shorter drug half life must therefore receive a larger daily dose at more frequent intervals to obtain the same peak gentamicin concentration. The authors emphasize the necessity to measure serum gentamicin levels in all burn patients with life threatening infections, to individualize the dosage for each patient to provide optimal peak concentration. -Peter K. Kottmeier
HEAD AND NECK An Adjunct to Ear Reconstruction. 1. W. Fox and M. T. Edgerton. Plast Reconstr Surg 58:663-667 (December), 1976.
protection offered. The flap, consisting of highly vascular tissue, is readily obtainable and can be utilized quite satisfactorily in either elective or emergency ear reconstructions. The article provides excellent pre- and postoperative pictures as well as diagramatic illustrations of operative technique.--d. B. Sokol S-Shaped
Repair
of the
S. 1. Sfenstrom. PI&
Unilakml
Reconstr
Surg
Cleft
lip.
58:668-672
(December), 1976. A modification of the Tennison triangular flap repair of the cleft lip is presented. Three innovations are clearly described which will assist the surgeon conversant with this lip repair. These are rounded rather than sharp Rap angles; a clear and simplified description of the markings utilized to create operative symmetry by virtue of understandable landmarks and the use of a ribbon of lead as a marking template; and finally technical suggestions of modifications to allow better insetting of the lateral into the medial lip elements, especially at the vermilion border. The technique is presented in a most lucid fashion, with diagrams of operative technique as well as excellent clinical photos depicting the satisfactory postoperative results.--/l. B. Sokol
The Fan Flap:
A technique is presented consisting of flap placement of tissue between the alloplastic or autogenous frame work implanted for ear reconstruction and the skin covering these skeletal elements. The procedure has been performed in 24 cases of ear reconstruction. Eighteen of these were performed for microtia, 2 for subtotal traumatic ear amputations, and 4 for burned ear reconstruction. The technique consists of the creation of a large fanshaped flap of temporal myofascia and cranial periosteum based along the upper and medial margins of the ear to be reconstructed. The flap, after elevation, is turned on itself (like the page of a book) to cover the implanted ear framework. The technique apparently has been effective in the prevention of implant exposure in the early postoperative period due primarily to hematoma, seroma, or infection. Late exposures following direct trauma and pressure necrosis are also reduced due to the greater
Cephalometric
Comparisons
the Wardill-Kilner
of the
Results of
and Von langenbeck
P&to-
plosHes. S. E. Bbhoro, H. Enemorlr and R. F. Thorp. Cleft
Palate
J 13:319-329
(October), 1976.
In this study an attempt was made to compare the effects of the two procedures at two stages of development, approximately 5 and I5 yr after surgery. The parameters used were cephalometric comparisons of the anterioposterior and vertical skeletal and dental relationships indicating facial growth and dental malocclusion respectively. Two hundred and two patients were examined, consisting of Caucasian females from Iowa and Denmark. The Wardill-Kilner (V/W-Y) group consisted of the pushback palatoplasties. Fifty-six Danish females with isolated clefts of the palate were compared with 47 noncleft females. The two subgroups were selected and matched on the basis of age and consisted of a mean age of 7.6 yr in 34 cleft subjects and a mean age of 18 yr in 22 cleft subjects. The Von Langenbeck group consisted of 42 females with isolated clefts compared with 57 noncleft fe-