958 QUARTERLY REVIEW OF LITERATURF:

be made by microscopic examination of the tissue. When secondary infection occurs the

primary condition is often overlooked. When the nature of the disease is suspected it is

important to seek roentgenographic evidence of other skeletal or visceral lesions. Mas-

toidectomies sometimes mu,st be performed in the event of complicating infection, and operation should be followed by roentgen-ray therapy, as the wounds heal slowly if this

is not done. Positive diagnosis by biopsy must be made before radiation is given.

In eosinophilic granuloma there is usually a solitary lesion, though there may be several. The lateral supraorbital region of the frontal bone and adjacent roof of the

orbit appear to be the site of predilection. Either surgical removal or irradiation of an

eosinophilic granuloma results in clearing of that lesion.

Seven cases are reported, in three of which there had been initial destructive lesions

of the temporal bone, and in four, solitary granuloma of the skull. In making the diag- nosis, the following conditions should be considered: metastatic osteolytic malignant

tumor, primary carcinoma, secondary cholesteatoma, primary eholesteatoma, osteomyelitis,

multiple myeloma, congenital dehiscences of the skull, tuberculosis, syphilis, and fungous

lesions.

T. .J. c‘.

PLASTIC PROCEDURES

Zur Technik der Rundlappenbildung. (Technique of the Formation of Flaps With Round

Pedicle.) H. Stiger. Ztschr. f. Stomatol. 46: 196, 1949.

Small details in the operating technique of round pedicle flaps for plastic surgery

are important for success. Length and width of the flap must be carefully determined

(Gillies). A model of fabric is useful, which has the measurements of the defect to be covered and the size of the pedicle necessary. It is usually three times as long as it is

wide. If the length is insufficient, detachment has to be done in several steps. The cuts

are usually made down to the fascia, and should be divergent toward the surface of the

skin. This is to avoid necrosis of the suture line from fat tissue bulging out between the

stitches. In patients with insufficient blood circulation it is advisable to cut only half

of the bridge pedicle and to wait until blood circulation in the pedicle has been re-estab-

lished. In still more difficult cases the flap is sutured back into its bed. Thus blood cir- culation comes mainly from the ends. Sometime later, the flap is cut loose and rolled.

Resistance of such flaps is markedly higher than flaps cut at one time.

The difficulty of suturing the end of the pedicle flap to the defect lies in the traction exerted on it in spite of all the devices to hold flap and defect tissue at a fixed distance.

Therefore, it is advisable to strengthen the suture fixation by wire held on both sides of

the suture (at a distance of 3 to 4 cm.) by plastic buttons. Suturing is done with horse-

hair or nylon thread.

Medication with acetylcholine and daily application of chlorphenol camphor have

proved helpful and decrease the healing period of the sutured flaps. Lately, Bepanthen

(Hoffmann-La Roche, Inc.) has proved successful (pantothenic acid in tablet form, in

ampules, and as an unguent). R. H. B.