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Traumatic loss of vermilion and mucocutaneous junction is not uncommon. It is usually treated by wedge resection of lip. When the defect is large, resection may lead to compromise of oral aperture. An alternative method of reconstruction with twin subcutaneous advancement flaps used in three cases is presented. The author has not come across a similar method in the literature for lip reconstruction.

Two patients with an ear defect, each reconstructed with a reverse-flow postauricular arterial flap are presented; one defect was caused by accidental exposure of bare cartilage at the posterior helix and the other by traumatic loss of earlobe. After the flaps were transposed, a line of auditory signals was dictated by Doppler probing, which suggested the presence of reverse blood flow in the flaps from the anteroauricular vessels. We believe that the reverse-flow postauricular arterial flap is a reliable and convenient optional tool in the reconstruction of auricular defects.

The first clinical use in man of the rectus femoris muscle, with overlying composite skin, as a free transplant by microneurovascular anastomoses to the upper extremity was done for traumatic loss of all digital and forearm flexors, which had been treated with primary flap coverage, and later, sural nerve grafts for the avulsed portions of the median and ulnar nerves.

A six-year-old boy sustained traumatic loss of the index finger middle phalanx of his right hand and one year after the accident the proximal phalanx of the fourth toe was transplanted to the index finger as a free graft. Four years after the operation x-ray films demonstrate acceptance of the graft and satisfactory function of the finger.

We report about 13 pregnancies after intra-uterine procedure in early pregnancy. In 12 cases infant and placenta were without any lesions. One infant had a traumatic loss of the left arm and shoulder caused by the ineffective interruption of pregnancy. Into discussion come the conditions in which we can support the wish to carry on pregnancy after an early intra-uterine procedure.

A series of 50 patients presented with total urinary incontinence secondary to traumatic loss of much or all of the urethral floor and bladder neck. Previously, the 50 patients had been subjected to 94 unsuccessful operations; this serves to indicate the challenging nature of the problem. Surgical reconstruction was accomplished by creating a small-caliber neourethra from the contractile tissue that remained in the urethral roof. In addition, 22 of the 50 patients (44 per cent) required a supplemental myocutaneous labial skin flap (12 patients) or a bulbocavernosus muscle flap of the Martius type (10 patients). A “second-stage” retropubic urethrovesical suspension was required in 20 patients. After a follow-up period of five to 15 years, 37 of the 50 patients (74 per cent) were cured and an additional four patients (8 per cent) were greatly improved.

We present two cases of traumatic loss of portions of the scalp, one by electrical burn and the other by avulsion. Both patients had large areas of osseous exposure, in which we made use of pericranial flaps taken from the back half of the skull in order to cover the exposed bone. At the same time, local flaps were made and skin grafted over the pericranial flap in a single surgical step using the usual surgical procedures.

The idea of the therapeutic manual is introduced. Principles are offered for writing material which may foster movement toward recovery among individuals who have experienced traumatic loss. An example of the application of these principles is provided in the form of a booklet for parents of children killed by drunken drivers.

The article describes the diagnostical and therapeutic problems, psychiatric patients with pathological grief exhibit. The grief reactions can be divided into stress-specific reactions (typical, chronic, inhibited, and delayed grief) and non-specific and mixed reactions (distorted grief). It is especially in the latter group the diagnostical difficulties show up. The reason is, that the symptomatology in these cases is very diffuse and the clinical picture may look like many other psychiatric diseases. A case with the clinical picture of depression caused by pathological grief is discussed in relationship to other kinds of depression. Regarding psychiatric patients it is often difficult to unveil the trauma/loss. In some patients there will be more than one loss, and the problem is to find out which one has caused the symptoms. Besides, sometimes the traumatic loss is unconscious. In order to unveil the trauma we have used a combined physio-psychotherapy, which in the uncovering phase is characterized by ...

Fifteen patients with suspected malignant lesions of the lower eyelids or inner canthal region, needing large excisions, were managed as day cases with spontaneous repair and simultaneous subtotal primary surgical reconstruction under local anaesthesia. For lesions confined to the lower eyelid, only those patients requiring full-thickness margin-inclusive (FTMI) excisions of more than half the horizontal extent of the eyelid are included in this study-the largest excision being 21 x 6 mm. For malignant lesions of the inner canthus, only those patients needing moderate to large excision of inner canthal skin and orbicularis with simultaneous FTMI excision of the medial one-third (8 x 5 mm) of the upper as well as the lower eyelid are included. The 16th patient had traumatic loss of inner canthal tissue. The final cosmetic and functional results in all 16 patients were satisfactory and comparable with the results of competent and in-toto primary surgical reconstructions. For large excisions at the inner canthus spontaneous with partial primary surgical repair allows the use of a less extensive and less elaborate surgical procedure that is within the capabilities of most ophthalmic surgeons.

The management of upper limb amputations is an important part of the practice of surgery of the hand. Reattachment of parts has opened dramatic new potentials, but elective amputation and wound closure after traumatic loss remain frequent and important operations. The negative aura surrounding these unpleasant events favors their quick disposition, but they demand the same measured judgement, technical skill, and concern that any reparative hand operation requires. Many basic surgical principles related to amputation are well established and must be followed. The difference in surgery under war conditions and civilian practice, where careful surveillance is possible, must be appreciated. Secondary procedures must be proposed on the basis of very careful study of the circumstances and the needs of each patient, above all avoiding unrealistic attempts at reconstruction. The aesthetics and the psychological impact cannot be ignored. Success can be measured only by the patient's recovery in a global sense, that is, how well he or she resumes normal life.

Es wird uber eigene Erfahrungen bei der kieferorthopadischen Behandlung der Nichtanlage bzw. des traumatischen Verlustes von Frontzahnen im Unterkiefer berichtet. Speziell wird auf die Problematik der Ausgleichsextraktion eingegangen. An Hand kasuistischer Beispiele werden die Behandlungsmoglichkeiten bei Fehlen eines, zweier bzw. dreier Frontzahne im Unterkiefer demonstriert.

1. With traumatic loss of the terminal volar pad of a thumb or index digit, the neurovascular island pedicle can serve as an immediate or secondary replacement in preference to a free graft or cross-finger pedicle. 2. A thumb reconstruction with pedicle covering alone has disadvantages of non-critical sensation and susceptibility to ulceration. Improved functional results are obtained when critical sensation and durability are secured by a neurovascular island flap. This supplemental measure sanctions the reconstruction of a thumb by pedicle and bone-graft procedures.

I shall report the case of a young girl who consulted me for a loss of substance of the left nostril, which I restored by means of a dermoepidermic flap taken from the arm. As the injury is almost always repaired with a flap taken from the cheek, with a pedicle in a state of continuity, I believe it will be interesting to publish the technic that I employed, and the results I obtained; this, as an entity, presents a new method. REPORT OF A CASE History.—Miss V. L., aged 17, consulted me on Aug. 25, 1926, for a wound in the nasal region. She told me that at the age of 8 years she had been bitten on the nose by a horse. She was not treated by a physician at that time and could not furnish me with any information about the consequences of the trauma.

Four patients who had traumatic loss of the penis were managed after the initial injury with a feminizing genitoplasty. Patient reconstruction ranged from 6 months to 3 years. The technique of feminizing genitoplasty is described. There were no instances of flap necrosis, urinary tract infection or urinary incontinence. Immediate results were considered to be cosmetically satisfactory in all patients. Followup ranged from 8 months to 23 years, with a median of 10.5 years. The long-term results have been particularly gratifying in 2 individuals who have been observed for more than 18 years. Early feminizing genitoplasty offers an excellent method of reconstruction of the external genitalia in the child with traumatic loss of the penis who is assigned a female sex of rearing.(J. Urol, 142: 799–801, 1989)

A 19-year-old male patient with a traumatic loss of the lateral femoral condyle underwent surgery where combined osteochondral auto- and allograft was used. Biopsy of the grafted cartilage at 1 1/2 years after transplantation revealed complete replacement of the hyaline cartilage by fibrocartilage. In spite of this finding the clinical and functional results were excellent.

A technique is described for the simultaneous restoration of traumatic loss of elbow flexors and overlying skin by transferring the latissimus dorsi muscle on its neurovascular pedicle with an island of overlying soft tissue. The procedure is safe and is performed in a single stage, thereby accelerating rehabilitation time. It provides bulk, contour, and coverage for the vital structures in the brachium and results in minimal donor morbidity.

Due to the shape and size of the patella, it can be used as a replacement for a destroyed tibial plateau or a missing condyle of the femur. Autologous grafts of this type have been described by Wilson and Jacobs (1952) for recent fractures of the head of the tibia and by Karpinski and Botting (1983) for old ones. Merle d’Aubigne reported on two war injuries, during 1945 and 1946, each involving a missing medial condyle of the femur which was replaced by using a petiolated patellar graft.

A case is described of traumatic loss of the distal quarter of the femoral shaft and its successful replacement with autogenous bone graft, with the surgical technique used. The cosmetic and functional results were gratifying.

Tissue regeneration obtained by using a limb lengthening apparatus has been used by the authors in five cases for the repair of traumatic loss of bone and soft tissue from the lower limbs. The principles of "regenerated tissue" introduced by llizarov for the lengthening of limbs were modified and applied to traumatological needs. Very encouraging results have been obtained.

This WRAIR Annual Report concerns research activities conducted by members of the Department of Military Psychiatry for the period 1 October 1987 - 30 September 1988. This report provides a status update of research projects to include a brief description of the purpose, major projects completed during this period, and those expected during the next fiscal year. Keywords: Stress, Coping, Survivor, Traumatic loss, Suicide, Cohesion, Morale, Performance, Reconstitution, Work, Leadership, Life events, Underemployment, Family, Wives, Spouse, Children.

I have noted estrangement from biological mothers and intolerance of intimate relationships in patients with an early history of primary surrogate mothering. This observation facilitated discovery of such early histories in 31 of 102 patients I examined during a five-year period. With a review of the literature, and clinical examples, I attempt to associate the estrangement and intolerance with the mother's exclusion resulting from her infant's close tie to a surrogate and the infant's inevitable traumatic loss of the latter. In the analyses of screen phenomena, mother and surrogate mother transferences, all peculiar to that caretaking, the surrogate is seen to emerge from obscurity. In the clinical examples (limited to losses of surrogates following the infant's eighteenth month) screen memories, dreams, and eclipse are found to possess a common feature: the image of the surrogate is screened by that of the mother. Biological mother and, in the countertransference, the analyst play a significant role in perpetuating the concealment of the surrogate.

By considering a set of in-depth interviews with eight bereaved mothers, this article seeks to explore ideas about what records are and what they do. Working to centre the voices and experiences of the bereaved mothers, the article first discusses some of the objects, events, places, and bodily traces they identified that function as records. It next considers the roles records and recordkeeping played for the parents interviewed, identifying four types of records work: proving life and love, parenting, continuing a relationship, and imagining. Records and recordkeeping are shown to be instrumental in the ongoing processing of traumatic loss as well as in the significant work of ensuring a life has meaning and is acknowledged. Finally, the interviews with parents also showed how deeply imbricated are love and grief as emotions and as motivations for recordkeeping, and the article ends by articulating a call for archivists to learn to “look with love.”, En étudiant un ensemble d’entrevues de fond avec huit mères endeuillées, cet article cherche à sonder différentes idées de ce que sont et ce que font les documents d’archives. Cherchant à recadrer les voix et les expériences des mères endeuillées, cet article aborde en premier lieu quelques-uns des objets, événements, lieux et traces corporelles qu’elles ont identifiés comme jouant un rôle documentaire. Il se penche ensuite sur le rôle que les documents et la tenue de documents ont joué pour les parents interviewés, identifiant quatre types de travail documentaire : témoigner de la vie et de l’amour, jouer son rôle de parent, entretenir une relation, et imaginer. Les documents et la tenue de documents s’avèrent être instrumentaux dans la gestion continue d’une perte traumatique ainsi que dans le travail important visant à garantir qu’une vie ait un sens et soit reconnue. Enfin, les entrevues avec des parents démontrent également combien l’amour et le deuil sont des sentiments intrinsèquement liés et profondément ancrés comme motivation à préserver des documents, et l’article se termine ainsi sur un appel aux archivistes à apprendre à « regarder avec amour ».

Paralysis of an extraocular muscle from any source is difficult to overcome, and traumatic loss of power represents a most perplexing problem. Seldom can even a partial restoration of power be developed, and operative intervention is really the only hope. This means rearrangement of muscles and substitution of some other power plant for the one put out of action. In all probability the external rectus muscles offer the best field for this procedure, and we feel from our experience that loss of action of the external rectus muscle can be compensated for by operative intervention. Two cases are reported here, in each of which outward rotation of the affected eye was completely lost and almost normal function was restored by transplantation of portions of the superior and inferior rectus muscles with recession of the internal rectus muscle and advancement of the external rectus muscle and Tenon's capsule. REPORT OF CASES

From 1971 to 1982, 110 osteochondral transplants with follow-up evaluation were performed for treatment of skeletal deficits caused by degenerative, traumatic, and neoplastic diseases largely involving the knee joint. Seventy-eight small-fragment fresh allografts were transplanted for repair of old tibial plateau osteochondral fractures, osteonecrosis, and unicompartmental osteoarthritis. Thirty-two large-fragment grafts were performed following en bloc excision of bone tumors. Of these, 22 were allografts, three were vascularized fibular autografts, and seven were a combination of allografts and vascularized fibular autografts. In this large-fragment group, three grafts have been removed for tumor recurrence, two for infection, and one for a stress fracture. The results of these transplants have proved particularly rewarding in the old plateau fractures, for traumatic loss of bone and cartilage (osteonecrosis), and after en bloc excision of giant cell tumors.

When a partial traumatic amputation of the terminal phalanx of a finger takes place, one of two conditions is found: Either the part is cut away clean with little damage to the remaining portion, or the part is crushed off and the tissues adjacent to the amputated portion are more or less traumatized. After the ordinary healing by granulation, we often find a sensitive stump in which the bone is covered only by a thin scar. The question arises as to the best method of early treatment, especially when the bone is exposed. In order to obtain a good functional result we must contrive to place a pad of tissue over the bone. This may be done rapidly and satisfactorily by shortening still more the exposed bone and closing the soft parts over it, but this method gives a shorter stump. In certain occupations the loss of all or a

Nicoladoni1was the first to describe the autoplastic transplantation of a toe for the traumatic loss of a finger. He successfully performed and described an operation in which he replaced a thumb by transplanting the second toe. Since then very few cases of successful transplantation of toes to replace lost fingers have been reported. REPORT OF CASE G. S., a man, aged 30, while operating a bread-slicing machine, Sept. 18, 1925, accidentally amputated the distal third of the middle finger of his right hand. The wound being recent and clean, I considered this a favorable opportunity to attempt grafting a toe to replace the missing finger. The day following the injury, the patient was placed under ether, and after exceptional care of the surgical field, I made an incision at the level of the head of the fifth metatarsal bone, transversely across the dorsum of the small toe of