Total reconstruction of the ear with auditory function: a two stage procedure

The rational treatment of severe microtia or anotia should be to restore not only the form but also the auditory function of the ear. To achieve this aim it is obvious that plastic surgeons must co-operate closely with an otologist: yet this degree of co-operation is seldom seen. This paper describes a two-stage procedure for total ear reconstruction with auditory function. In stage I, a tympanoplasty is performed before transplantation of the carved cartilage framework. Stage II consists of elevation of the reconstructed auricle and transplantation of a full-thickness skin graft to the post-auricular defect. Certain modifications of the operative techniques that we have found useful are discussed in detail.

Clinical and histological observations on the application of intermingled auto- and porcine-skin heterografts in third degree burns

Escharectomy and skin grafting with both homograft and porcine skin has become an effective method in treating massive third degree burns. Seventeen patients and 21 operations of intermingled transplantation of auto- and fresh porcine skin heterografts after escharectomy of the severe burn wounds have been carried out since March 1973. Clinical and histological data are summarized, among which we observed the 'fusing phenomena' of auto- and porcine skin heterografts in 6 patients. Vascularization, 'turning red', viability and rejection as well as ways to improve the results of the grafting method are discussed. No vascular communication between fresh porcine skin and the host wound has been observed during the early postoperative period. The cause of 'turning red' is a reddish transudation between the graft and the host wound seen through the thin porcine skin. Based on histological observations, porcine skin is viable after transplantation. With nutritional support apparently coming from the underlying plasma and tissue fluid. Eventually the process of rejection is similar to that of homograft Better results are found with porcine skin grafts 0.4-0.5 mm in thickness placed 0.5-0.75 cm apart. In order to avoid large sloughing wound surfaces less than 20 per cent area of porcine skin coverage is advisable.

The primary hamster kidney cell rabies vaccine: adaptation of viral strain, production of vaccine, and pre- and postexposure treatment

The hamster kidney cell rabies vaccine was investigated as a substitute for classical nervous tissue rabies vaccine. The Beijing strain of fixed rabies virus was adapted to primary hamster kidney cells (PHKCs), and four types of rabies vaccine (plain, adjuvant, concentrated, and concentrated adjuvant vaccines) were developed for human use. The potencies of the vaccines met the requirements of the World Health Organization, and these vaccines elicited rather satisfactory antibody responses in volunteers. The postexposure use of vaccine was evaluated in 301 individuals, 97 of whom had been bitten by proven rabid animals. None of the individuals contracted rabies during the observation period. After several years of field trials with both pre- and postexposure vaccines, the evidence indicates that the PHKC rabies vaccines are effective and safe for human use.