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This article discusses the acute, intermediate, and long-term care of patients with burns of the nose and ears. A thermal injury to these facial features results in extreme disfigurement that is immediately obvious to all who see the patient. The complex structure of the nose and ear makes their reconstruction artistically and technically demanding. A thorough knowledge of what is possible is necessary to understand what is best for each patient.

In patients with cleft lip and palate, large oronasal fistulae (ONF) are formidable but rare reconstructive problems. There are many effective techniques for local flap closure of small fistulae, but large hard palate fistulae are generally closed with two-stage tongue flaps. Instead, we propose the selective use of the buccinator mucosal island flap (BMIF) based on the facial artery. We have used the flap with success for a variety of etiologies. In this article, we describe the surgical anatomy and technique for the BMIF as it applies to large ONFs for failed cleft palate repair. A representative, previously unpublished case in an adult with bilateral cleft lip and palate is presented in detail.

Standard technique for hair transplantation includes plug composite grafts placed in circular recipient defects of smaller diameter. The plugs can also be placed in slit incisions that are temporarily dilated to accommodate grafts. Two drawbacks of these techniques are the appearance of row cropping resulting from the regular pattern and compression of individual grafts caused by scar contracture. These drawbacks result in tufting and a "doll's head" appearance. The expansile Mercedes incision as described here camouflages these failings. Donor minigrafts are taken with a biopsy punch knife or as strips in a standard fashion. A Mercedes logo-shaped defect is then made at the recipient site using a no. 11 scalpel to create a three-armed stellate incision. The incisions are rapidly made with the axis oriented parallel to the direction of the native hair shafts. The graft is then pushed in flush with the skin. The triangulation eliminates compression of grafts because they are spread in three directions rather than squeezing in a tight circular or slit configuration. The use of the stellate incision along with altering its rotational orientation in a haphazard pattern also prevents row cropping. Thus, the Mercedes incision is quicker and yields an overall improved result.

Fresh isolated myocardial, elastic-arterial, and valvular tissues from seven canine hearts were irradiated by argon laser. Irradiation was transmitted through 300 and 400 micron flexible quartz fiberoptic elements. Minimal power densities for vaporization of the myocardial, arterial, and valvular tissues were 80, 90, and 110 W/cm2, respectively, with maximal vaporization distances (fiberoptic tip to tissue) of 4 mm, 1 mm, and 1 mm, respectively. Irradiation of the valves at power densities approaching perforation caused contraction of the tissue. When tissue vaporization occurred, histologic examination of irradiated tissues showed a central crater surrounded by sequential layers of char, vaporization, and coagulation necrosis. These findings were common to all cardiac tissues. Additional findings unique to myocardium were a normal-appearing myocardial layer (skip-area), circumferential halo, and tissue clefts. Elastic arteries showed concentration of necrosis around the collagen and elastic fibers. Valvular damage was the most extensive and also included contraction of adjacent valvular tissue and endocardial sloughing.