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A new technique of syndactyly release is described. The technique differs from the standard methods in that more digital flaps are used, and these are longer and are not defatted. A single stitch is applied to secure the tip of the flap and the defects between the flaps are not closed or grafted, hence the term “open” technique. Eight patients had 12 webs released using this operation. We compare this technique with 12 patients who had a total of 19 webs released using the standard technique. Patients were assessed for six parameters of operative success.

The aim of cleft palate surgery is to minimise damage which results in impaired maxillary growth, and to maximise outcome in terms of velopharyngeal function. Techniques developed by the author, building on work by many and employed by the North Thames Cleft Lip and Palate Centre at Great Ormond Street Hospital/St Andrew's Centre (GOStA) appears to offer one way of achieving these aims. However, the learning curve is long.

The technique for primary correction of the cleft lip and nose, as practised by The North Thames Cleft Lip and Palate Centre at Great Ormond Street Hospital/St Andrew's Centre (GOStA) has evolved over 28 years of personal experience. It is an amalgamation of techniques developed by many others with some personal modifications. Patients are routinely audited at 5, 10, 15 and 20 years and outcomes evaluated and compared with other centres where possible. Secondary surgery of lip and nose is based on the same principles of anatomical reconstruction used in the primary surgery.

Pyoderma gangrenosum is an enigmatic disorder of rapidly spreading ulceration virtually indistinguishable from synergistic gangrene. Because management of the two conditions is so different correct diagnosis is crucial.

The aims in a current study of dermis and scar tissue using the scanning electron microscope are: (1) to maintain the orientation of the specimen, (2) to preserve the in vivo architecture, and (3) to expose a satisfactory surface. A technique which best fulfils these requirements involves glutaraldehyde fixation of a splinted specimen, freeze-fracturing using a modified pair of pliers, freeze-drying again after washing. Consistently satisfactory specimens have been obtained, which provide information about fibre architecture and cell distribution.

A method for assessing hand function following loss of the long finger extensors in Zones 6 and 7 (Verdan, 1968) is described. It relies on a number of mechanical and functional tests combined with a detailed questionnaire.

The clinical details of two patients with benign mediastinal teratomata are presented. Both patients developed inflammation of the root of the neck, the first after a small dose of radiotherapy and the second after a larger dose of radiotherapy and exploration of the thoracic inlet. In both cases, exploration of the inflamed area was followed by persistent discharge of fluid which was sterile on culture. In the first case, this was found to have a high cholesterol, lipid, and amylase content. In both cases, a benign mixed teratoma, with contents including intestinal epithelium and pancreatic tissue, was removed at thoracotomy. The suggestion is made that leakage of digestive enzymes from pancreatic, intestinal or salivary tissue may be a cause of inflammation in and around teratomata, especially after surgical exploration. Early thoracotomy is advised when the condition is recognized.

This study examines the premise that, following severe injuries to the dorsum of the hand, reconstruction of the long extensor tendons of the fingers may not be necessary for many patients. The long-term hand function of nine patients who sustained such injuries and had operations to provide skin cover only, has been comprehensively assessed using objective tests and a detailed questionnaire. It is concluded that provision of skin cover followed by intensive early mobilisation may be an adequate management of these injuries.