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              SEPTEMBER, 2004                                  VOL 3/04

                                                              impact may lead to cerebrospinal fluid leak, cerebral
NASOETHMOIDAL FRACTURES                                       injury, or globe injuries.
                                                              When telecanthus occurs, the medial canthal tendon
                                                              (MCT) has become displaced from its native position.
                                                              Usually, the tendon remains attached to a segment of

T       he nasoethmoid fracture represents a challenging
        surgical problem due to the complexity and
        density of the anatomic components of the area.
Because of the functional and aesthetic implications of
                                                              bone that has become displaced. For telecanthus to
                                                              occur, the fracture must involve at least 4 sites: the
                                                              medial orbital wall, the nasomaxillary buttress/inferior
                                                              orbital rim, the frontomaxillary junction, and the lateral
the medial canthus, nasolacrimal system, and                  nasal bone
intraorbital contents, appropriate and timely treatment
is crucial to avoid unfavorable sequelae.                     Clinical Features
As the skeletal framework of the area is maximally            A. Broad, flattened, depressed nasal root often with an
supportive against forces in the vertical axis but weak       accompanying laceration
in the horizontal axis (particularly against                  B. Periorbital ecchymosis and considerable swelling
anteroposterior forces), central facial impact is likely to   and difficulty of inspection
cause these types of injuries. Furthermore, the anterior      C. Traumatic telecanthus
prominence of the NOE complex in the mid face                 1. rounded medial canthus with prominent epicanthal
makes it susceptible to injury. Nasoethmoid fractures         folds
typically result from a forceful blow to the central          2. loss of caruncle and shortened palpebral fissure
aspect of the midface. Motor vehicle accidents are the        3. almond shaped palpebral fissure
most common source of injury, followed by assault. If         4. accentuated nasojugal fold due to posterior canthal
a small object hits the nasal bridge with higher energy,      displacement
a naso-orbital or nasoethmoidal fracture may result: the      5. normal intercanthal distance is roughly equal to the
nasal pyramid is severely fractured and forced                interpalpebral distance
posteriorly. The medial eye structures (the medial            6. with edema obscuring the medial palpebral angle,
canthal ligament and lachrymal apparatus) are often           this width may be difficult to ascertain
injured. Often there are also fractures of the floor of the   7. alternatively, one can measure the interpupillary
anterior cranial fossa, with tearing of the dura              distance which is normally twice the intercanthal
providing a pathway for cerebrospinal fluid                   distance
rhinorrhoea.                                                  8. normal values are 60 to 70 and 30 to 35 mm,
Less forceful injuries are needed to cause NOE                respectively
fractures than zygomatic, maxillary, or frontal               9. bowstring test will demonstrate laxity of the upper,
fractures. In general, these fractures occur with or          lower, or both eyelids
without comminution of bone. In the former situation,         D. Epiphora
if the fracture segments are displaced, the nasal bones       Epiphora is not a reliable acute sign of lachrymal
and frontal process of the maxilla may be telescoped          system injury because it is often present in the
posteriorly in between the two orbits (Fig.), beneath the     immediate post-injury period. The Jones I and Jones
frontal bone, thus producing hypertelorism. In patients       II tests will document the integrity of the system and
with comminution, the bony segments may spread into           localize the anatomic site of injury
adjacent spaces. They may spread medially into the            E. CSF rhinorrhoea
nasal cavity, superiorly to the anterior cranial fossa,       1. may be present with cribriform injury
and laterally into the orbit. For this reason, high-energy    2. reflex watery rhinorrhoea is common
3. filter paper test or protein and glucose                   G. Techniques of repair
determinations should be done on any clear fluid              I. The bony skeleton
draining from the nose                                        a. extensive comminution and fragmentation can be
F. Diplopia                                                   expected and each fragment must be identified and
1. may be due to orbital blowout with entrapment,             preserved
edema, or trochlear dehiscence                                b. midfacial and frontal fractures must be reduced
2. forced duction tests will help sort these out              and fixated prior to addressing the nasoethmoid
Preoperative Workup                                           c. the frontal process of the maxilla and the nasal
A. A high index of suspicion for the possibility of           bones should be aligned with the frontal bone and
nasoethmoid complex fracture is necessary; most of            directly wired
these patients will be having multiple injuries and            Asch forceps aid reduction. A skin hook may be
this injury will be easily overlooked                         inserted behind impacted bones to provide additional
1. document the intercanthal distance                         traction. The various bone fragments are aligned and
2. determine the laxity of the lids                           directly wired to each other with small stainless steel
3. be alert to the characteristic clinical appearance         wire or even chromic catgut where wiring is
B. preoperative ophthalmologic consultation is a              impractical
must                                                          II. The medial canthal tendon
1. 10% of all major periorbital trauma will also have         A. Unilateral injury
an injury to the globe                                        1. with adequate exposure, identification of the
a. corneal laceration                                         tendon is usually not difficult
b. open globe                                                 2. it is often attached to a small fragment of
c. hyphema                                                    lachrymal bone
d. detached retina                                            3. occasionally, the tendon will be completely
2. examination should include visual acuity, visual           avulsed from bone
fields, indirect ophthalmoscopy, forced duction               4. when comminution is minimal, and a small
testing, and the Jones tests of lachrymal integrity           fragment remains attached to the tendon, some
C. Thoroughly delineate the extent of all facial              authors recommend direct reattachment of the tendon
injuries so that the repair can be performed in an            by wiring the bone fragment to the anterior lacrimal
orderly fashion                                               crest
D. CT demonstrates the presence of all facial                 5. superior stabilization is obtained, however, by
fractures and the extent of comminution of the                wiring the bone fragment transnasally to the opposite
complex, in addition to delineating the integrity of          anterior lachrymal crest
the cribriform plate and anterior cranial fossa               6. 0.3 or 0.4 mm stainless steel wire is passed through
E. Always obtain preoperative photographs                     the tendon or bone twice; the ends are then passed
                                                              transnasally through pre-drilled holes in the opposite
Treatment                                                     anterior lachrymal crest with a curved awl or curved
A. At the time of surgery, separate repairs are               spinal needle
performed on the skeletal framework, the medial               7. the ends are then twisted over a toggle wire
canthus, and the lachrymal system                             b. Bilateral injury
B. In the past, closed reduction with transnasal wiring       1. with bilateral displacement, the canthal tendons are
over lead plates was the standard mode of treatment           wired to each other transnasally
C. This approach has proved unsatisfactory as                 2. two holes are drilled in each frontal process of the
1. nasofrontal separation will remain unreduced               maxilla at the anterior lachrymal crest
2. transnasal wiring placed via an external approach          3. again, wires are passed transnasally and tightened
will lie anterior to the frontal process of the maxilla       over a toggle wire
3. local skin necrosis under the compression plates is        4. in this manner, the medial canthal tendons are
common                                                        drawn together
4. a high incidence of postoperative telecanthus is           5. slight over-correction is desirable
seen                                                          6. in the case of bilateral avulsions, the tendons are
5. lachrymal dysfunction is not addressed                     wired directly to each other at the level of the anterior
D. The concept of early exploration and open                  lachrymal crest
reduction with direct repair of these injuries has            7. the cut ends of the wires are carefully buried in the
evolved over the past 20 years in response to this            drill holes
high rate of complications and poor results                   8. removal of the wires is seldom necessary
E. It has become clear that accurate, stable fracture         9. some authors recommend wiring of the tendons
repair and canthal tendon alignment via an open               transnasally over fashioned silastic buttons
approach yields better cosmetic and functional results        a. decreased scar from the compression
F. The surgical approach can vary considerably                b. the wires can be removed easily
1. through an existing laceration                             c. less chance of wire ―cutout‖
2. bilateral ―Z‖ incisions in the medial canthal region       III. Lachrymal repairs
3. ―W‖ or ―H‖ shaped incisions
4. bicoronal approach

a. lachrymal system injuries should be repaired                   memory enhancing chip, researchers hope to pave the
acutely because exposure is excellent and acute repair            way for true memory implant devices which would
will often obviate the need for second procedures                 help to fix Alzheimer‘s disease or just boost the fading
b. the Jones I and II tests will indicate the level of            memory of senility. Deep brain stimulation (DBS) for
obstruction                                                       Parkinson‘s disease is already being practiced, so why
c. if lachrymal repairs are indicated, they should be             doubt these researches?
completed prior to tightening of the transnasal wiring            Another fast developing areas are implants to help the
d. if doubt as to the integrity of the system still exists        blind to see. Vision aids range from the relatively
at the time of surgery, direct probing with lachrymal             simple – a 5000 photodiode array glued to the back of
probes can localized obstructions and lacerations                 the eyeball which directly converts incoming light to
e. injuries are most often located in the lachrymal               electrical signals and so artificially replaces damaged
gland itself or at the junction of the sac and                    retinal cells in Retinitis Pigmentosa to a true Bionic
nasolacrimal duct                                                 Eye in which a miniature camera mounted on
f. injuries here call for acute dacrocystrhinostomy               spectacles feeds signals by wires to electrodes
g. in those cases where there is severe comminution a             embedded in the visual cortex. The quality of image
modified DCR may be performed                                     thus produced leaves a lot to be desired, but these are
A silicone catheters are used to intubate the                     early days and the technology can only improve.
canaliculi, pass through the sac and into the nose                The prospect looks much better for implants to aid the
either via a preexisting dehiscence or a rhinostomy.              quadriplegics. Researchers at Duke University and
The ends are ties together intranasally and left in               elsewhere have shown that even modest array of a few
place at least 6 weeks. A new tract will mucosalize               hundred electrodes can pick up enough signals from
                                                                  motor cortex area to control a computer cursor by
The canalicular lacerations can also be closed over               ―thought‖ alone. Metal electrodes can destroy brain
the silicone tubing with 10-0 nylon sutures                       tissue as the brain moves in the cranium, so the
                                                                  circuitry is being embedded in porous glass pellets.
Postoperative Considerations                                      Smearing a pellet with growth factor encourages
A. Prophylactic antibiotics are indicated in the                  nearby neurons to sprout connections directly to it. A
perioperative period for 5-7 days                                 still bigger problem is getting the signal out of he brain
B. Nasal splints are removed in 2 weeks                           and a skullcap that both supplies power and reads data
C. External silastic buttons, if used, are removed with           from transmitters cemented in the skull bones by
the wires in 4 weeks                                              magnetic current induction has solved this. Such
D. Lachrymal silicone canulas remain in place at                  cortical implants will one day drive wheel chairs,
least 6 weeks                                                     operate light switches and operate prosthetic hands.
E. Postoperative follow-up by the ophthalmologist is              One may have doubts about these neuro-implants,
indicated to ensure early detection and correction of             whether they will ever move out of a strictly
diplopia, epiphora, dacrocystitis, etc                            experimental setting to the clinical world and
                                                                  eventually become an everyday consumer item. One
                                                                  may even doubt whether there will be willing patients,
                                                                  who would risk a brain operation to insert a chip, what

                                                                  if a newer version of the same hits the market six
                                                                  months later! But you never know, who would have
                                                                  thought 100 years ago that people would be subjecting
                                                                  themselves to major surgery to remove body fat or get
                                                                  a larger penis?

                                                                  SAVING FACES – BOOK REVIEW
The human brain is that master computer whose
software are impossible to pirate and the hardware is
petty hard to mimic. So have we given up on this
                                                                  Dr. H.S. Adenwalla, Head of the Charles Pinto Centre
venture? Far from it, various gizmos are on the
                                                                  for Cleft Lip & Palate, Jubilee Mission Medical
drawing board and in animal trial, which would let a
                                                                  College & Research Institute, Trichur on Editor‘s
blind man see, a deaf man hear, a quadriplegic move
                                                                  personal request.
about, and an Alzheimer‘s disease patient regain his
memory. These are called ‗Neuro-prosthetic devices.‘
The highly regular neural architecture of the                     Review of book entitled ―Saving Faces‖ by Ralph D.
Hippocampus of the rat brain has attracted the                    Millard, a Plastic Surgeon‘s Remarkable Story 2003,
researchers of the University of Southern California              Write Stuff Enterprises Inc.
(USC). After damaging a part of it, they are replacing it         This is a book that every reconstructive surgeon should
with a chip with Hippocampus mimicking circuitry,                 read. It is this remarkable man‘s story, which really
thus creating artificial pathway to restore neural traffic.       cannot be separated from his work. Intimate details of
Thus patching across damaged brain by a tailored                  his life are interwoven with case histories of so many

firsts in reconstructive surgery. And it was not ―roses,         Donato LaRossa, Harold McComb. D. Ralf Millard Jr.,
roses all the way‖. For his brilliance his sincerity and         John Mulliken, M. Samuel Noordhoff and Brian
his frankness were often mistaken for arrogance and so           Sommerland.
the American Society of Plastic and Reconstructive
Surgeons turned him down thrice for membership.                  These are a set of three CDs one each on Unilateral
                                                                 Cleft Lip, Bilateral Cleft Lip and Cleft Palate. An
A man of indomitable courage, he fought his way to               effort has been made to compare and contrast
the pinnacle of eminence in his chosen profession. You           techniques for the four vital components of lip repair –
see in this book a charismatic personality, a master             downward rotation of medial segment, primary nasal
surgeon, a great innovator and an inspiring teacher. He          correction, mobilization of lateral lip and alar base and
was the first to put on paper the principles that his            repair of lip. The CD on palate repair emphasizes the
mentor Sir Harold Gillies enunciated and called it his           details of mobilization of the neuro-vascular bundle
10 commandments to which he added a few more. He                 and muscle repair of soft palate. The different
always went back to them in his work and in his                  techniques presented in it are; discrete muscle
teaching. He once said, ―the difference between a great          dissection as performed by Sommerland and Cutting,
plastic surgeon and a good one is imagination‖.                  and Furlow Z-plasty as performed by Donato LaRossa.

Talking about clefts he said ―All art demands freedom            The surgeons using these videos will perhaps learn
for its vitality and therefore do not force a rigid method       faster, retain information longer and ultimately become
in the mouth of every cleft child. The rotational                better Cleft Surgeons. Undoubtedly another very
advancement is such a method, you cut as you go and              important contribution from Smile Train towards the
stitch where you need to. There is a blue print but it is        development of Cleft Lip and Palate surgery!
flexible. The plan is never your master‖, and then again
he says, ―A cleft lip surgeon must be a perfectionist,
free to aspire to unattainable goals and willing to work
in millimeters. Before a technique can be made to
attain its greatest potential, the surgeon must not only
be familiar with it, and believe in it but actually woo it
to its ultimate.‖
I quote from the masterpiece a remarkable paragraph
―He who uses his hands is a labourer. He who uses his
hands, his eyes and his brains is an artisan. He who             BI-ANNUAL CONFERENCE OF INDIAN
uses his hands, his eyes, his brains and his heart is an         SOCIETY FOR RECONSTRUCTIVE
artist. In plastic surgery we must have artists, and             MICROSURGERY (ISRM 2004)
therefore as a corollary I must say that what one does is
not so important as how one does it and who does it. In
another part of the book he says ―In surgery it is               The Bi-annual Conference of Indian Society of
important to acknowledge limitations in order to do no           Reconstructive Microsurgery ISRM 2004 was held on
harm. Probably the greatest potential trouble lurks in           July 3 and 4, 2004 in Hotel Taj Residency in
the lethal combination of ignorance and arrogance.               Hyderabad. The team of Dr. V. Sudhakar Prasad and
                                                                 Dr. Y.Venkat Rao organized an academically enriching
This biography like his ―Cleft Craft‖ and The                    scientific programme, stressing predominantly on the
―Principles and Art of plastic surgery‖ which he wrote           practical applications of microsurgery through lectures
with Sir Harold Gillies reads like a novel.                      and video sessions.
                                                                 The Pioneer Lecture by Professor Abraham Thomas
                                                                 was a nostalgic journey down the years. He spoke with
                                                                 great warmth about his teacher Marko Godina and his
THE SMILE TRAIN VIRTUAL SURGERY CDs                              pioneering work in replantation and the fine work of
                                                                 the CMC, Ludhiana department in the 70s and 80s as
                                                                 they pioneered replantation surgery in India. The
In the Smile Train Virtual Surgery Lab at New York               lecture on ‗Past, Present and Future of Head & Neck
University a small team under the leadership of Dr.              Microsurgery‘ by Prof. Achilles Thomas of Canada
Court Cutting developed a series of Cleft Surgery                was a refreshingly honest analysis of problems and
videos that leverage the power of virtual technology             solutions in micro surgical reconstructions. He
and 3-D animation. The fundamental nature and                    emphasized on the use of the medial scapular flap as an
complexity of Cleft Surgery makes it difficult to teach          excellent donor for Head & Neck reconstructions
using 2-D textbook diagrams and traditional surgical             following tumor ablation.
footage. Using special virtual surgery software that this        Prof. R. Venkataswamy‘s ‗Decision making in
team developed, and an advanced animation software               Brachial Plexus‘ had a clear analysis with good
these researchers were able to reduce the most complex           guidelines for the surgeons in this field. Speaking on
techniques to simple and easy to understand animation.           the possible algorithms which can be used to decide on
Dr. Cutting was helped in this monumental project by a           the clinical and surgical management of Brachial
galaxy of Cleft surgery exponents including Drs.                 plexus injuries he emphasized the need to diagnose

these lesions early, educate our colleagues to refer            Prof. D. Mukunda Reddy, the course director had
these cases to us early and the rationale for early and         arranged a two-day workshop attended by 98 delegates.
aggressive management of these lesions. He dwelt                On the first day 4 flaps were done: Anterolateral Thigh
upon the newer modalities of surgical options directed          Flap, Free fibula, Lateral Arm flap and Latissimus
at more specific target nerves and muscles such as the          Dorsi flap. On the second day there were 2 advanced
ICN to nerve to biceps transfer etc. Dr. Mukund                 flaps-Double Gracilis functional muscle transfer and
Thatte‘s paper on ‗ Surgical Technique in Brachial              Second toe transfer. Throughout the operative sessions
Plexus Surgery‘ was an anatomical deliberation,                 there was minute-to-minute interaction between the
highlighting the steps of exposure of all possible areas        operating surgeons and the audience by an excellent
required in plexus surgery.                                     close circuit audio-visual system. The back ground
The symposium on Microsurgery of the Hand had 7                 information of the cases and the details of flaps in use
erudite speakers with Professor G. Balakrishnan from            were provided to the delegates and the operators also
Chennai as the convener. Dr Jayakumar from Cochin               presented their experiences with each of the flaps.
showed his extensive experience with replantations at
different levels and offered important tips on technique
and decision-making. Dr R. Khazanchi from New
Delhi spoke on the different techniques of thumb
reconstruction in congenital absence and post-                  1st. INTERNATIONAL SYMPOSIUM ON HAND
traumatic loss at different levels. Dr Balakrishnan             SURGERY AND THE ADVANCES IN HAND
presented his experiences with vascularized bone grafts         THERAPY
and emphasized on the versatility of the fibula for
reconstruction. Dr Raja Sabapathy gave invaluable
practical tips in the management of peripheral nerve            The 1st. International Symposium on Hand Surgery
injuries. The video session on Basic Microsurgical              and the advances in Hand Therapy was held in Jakarta
Techniques by Dr. R. Sabhapathy was very useful for             Convention Centre, Jakarta, Indonesia on August 20
young trainees.                                                 and 21, 2004 under the Chairmanship of Dr. Djoko
Dr Gautam Biswas chaired the symposium on Head                  Roeshadi. The Conference was preceeded by two
and Neck Microsurgery. Professor Thomas showed us               concurrently running cadaver dissection workshops in
some excellent results of mandibular reconstruction             Department of Forensic Medicine, FMUI / Cipto
using the ostecutaneous radial artery forearm flap and          Mangunkusumo Hospital. Instructors, Soo-Heong Tan
laid particular emphasis on the amount of bone to be            and Lam-Chuan Teoh of Singapore conducted a
harvested and its precise location to avoid fractures of        workshop on Local and Regional Flaps of Hand.
the radius as also fashioning of the donor site to reduce       Common flaps like Reverse Radial Forearm Flap,
the morbidity of the RAFF donor site. He also spoke             Posterior Interosseous Flap, Littler Flap, Kite Flap
on Evidence based microsurgery and how certain                  were demonstrated with the objective of delineating
techniques are more cost-effective than others                  their use for resurfacing various defects of the hand
This Conference was also marked by the presentation             and understanding their tissue perfusion and of the
of some excellent free papers on mandibular                     functional vascular anatomy. Dr. Poong-Taek Kim of
reconstruction and replantations. The hospitality was           Korea conducted the second cadaver dissection
excellent and the genuine warmth of the organizers              workshop on tendon transfers and highlighted those
palpable. It was a memorable bi-annual meeting.                 used to restore wrist and digital extension (radial
                                                                nerve), thumb opposition (median nerve), intrinsic
                                                                balance (ulnar nerve) with passing reference to the
                                                                Brachial Plexus Injury patients.
WORKSHOP ON RAPID FREE FLAP                                     The Conference itself had some excellent
TRANSFER                                                        presentations. Dr. Chih-Hung Lin of Taiwan presented
                                                                his views on ‗Evaluation and advances in re-plantation
                                                                surgery‘ and Dr. Byung Chae Cho of Korea talked
The Workshop on Rapid Free Flap Harvesting was                  about ‗Small flaps on hand.‘ Separate panel discussions
inaugurated Prof C.R. Sundararajan from Chennai, Past           on ‗What‘s New on Fractures and Dislocations – of
President of Association of Plastic Surgeons of India.          carpus and of phalanges and metacarpals‘ were very
The Department of Plastic Surgery, Nizam Institute of           interesting. Another panel discussion on 'What's new
Medical Sciences (NIMS), Hyderabad, which                       on innovations in rehabilitation for fractures and
organized this workshop, on this occasion, also started         dislocations?' was also very illuminating. Soft tissue
a scheme "Salvage a limb and Save a family" and this            injuries of the hand were categorized into finger tip
was dedicated to poor and needy of the state of Andhra          injuries, tendon injuries, nerve injuries and nerve
Pradesh by the director of Nizam Institute of Medical           compression syndromes and discussed in separate and
Sciences, Padmasree Kakarla Subba Rao. Again to                 very useful symposia. Mutilating Injuries were
commemorate this event, Prof D.L.N Prasad, Emeritus             discussed in three sub-groups – Replantation,
Professor of N.I.M.S also inaugurated novel E                   Resurfacing and Reconstruction. Dr. Yoshikazu Ikuta
consultation scheme- patients and doctors alike can             of Japan presented two exiting papers on ‗Free muscle
send Email queries to

graft in the upper limb‘ and ‗Osteochondral graft for          KNOWING ACNE’S GENETIC CODE COULD
reconstruction of small joint in the hand‘. Dr. Ashok          IMPROVE TREATMENT
Gupta of India presented his experiences on Primary
free/ island radial flaps for composite reconstruction
and Dr. Lam-Chuan Teoh of Singapore deliberated on             German researcher Dr. Holger Bruggemann and his
‗The role of lateral arm flap in reconstruction of             colleagues say they have the genetic code of a microbe
mutilated hand injuries‘ and on ‗Heterodigital                 that won't kill anybody but contributes to one of the
arterialized flaps for larger finger wounds‘. Dr.              great torments of adolescence. Reporting in the journal
Aymeric Lim of Singapore discussed the role of                 Science, the researchers describe the genome of the
Fascial vascular island flap in finger reconstruction.         bacterium, Propionibacterium acnes. Not always an
Other aspects of Hand Surgery like Burn Contractures,          evildoer, the bacteria sit on the surface of everyone's
Regional Anaesthesia, and Postoperative rehabilitation         skin. The trouble develops in the blocked pores that are
were also covered in the Conference. Instructional             the beginnings of acne pimples and this bacterium
course lectures on ‗How to achieve maximum function            starts an inflammation. Acne begins when hair follicles
after tendon repair?‘, ‗Anaesthesia for Hand Surgery‘,         become blocked with excess skin cells. Sebum
and ‗Recent techniques in rehabilitation of hand               produced by sebaceous glands within the skin cannot
contracture‘ were also very useful.                            flow to the surface and instead backs up within the
                                                               follicle. As the sebum collects, it produces a swollen
                                                               pocket that is the basis of a pimple. Under normal
                                                               circumstances, the P.acnes bacteria live harmlessly on
ACROSS SEVEN                                                   the skin. But trapped inside the follicle, they break
                                                               down the sebum into components that inflame the skin,

SEAS                                                           making it red, swollen and sometimes warm to the

SENATE OKs COSMETIC SURGERY BILL                               Contrary to popular belief, hygiene and diet have little
                                                               to do with the condition. Though treatments have made
                                                               acne less onerous than it was a generation ago,
Los Angeles Times August 18, 2004                              scientists hope that the genetic blueprint could lead to
                                                               better drugs with fewer side effects. In theory, such
                                                               drugs could target specific actions of the bacteria,
SACRAMENTO — Resolving an impassioned turf
                                                               which work in different ways to inflame the skin. "We
battle between doctors and dentists, the California
                                                               have got the tool in hand," said, the lead author of the
Senate voted Tuesday to allow dentists trained in
                                                               report. "Now we have the chance to find good targets."
surgery to perform elective cosmetic operations on the
face. The bill would give new privileges only to several
hundred oral surgeons — dentists who complete a                Bruggemann, a microbiologist at the Pasteur Institute
special surgery programme. But the clash was one of            in Paris, directed the research while at the Institute of
the most intense this year, given the lucrative prize          Microbiology and Genetics in Gottingen. Colleagues
involved: California‘s ever-expanding market for               there and at the University of Ulm, also in Germany,
cosmetic surgery. The measure now goes to Gov.                 participated. Dr. Patrick McElgunn, an assistant
Arnold Schwarzenegger, who has not indicated                   professor of dermatology at the Johns Hopkins School
whether he would sign it into law.                             of Medicine said "this allows us a window to look at
‖The Governor‘s wise use of his veto power is the last         certain therapies that would be more specific," but he
chance to save Californians from dangerous legislation         did not forget to remind, ―Acne is like everything else
that would allow dental surgeons without medical               in life. It's multifactorial‖.
degrees to perform cosmetic plastic surgery,‖ said Dr.
Michael G. Cedars, president of the California Society
of Plastic Surgeons.                                           SKIN SUBSTITUTE – FOR A DIFFERENT USE
Plastic surgeons and the California Medical Assn. had
argued that the bill would endanger public safety              Scientists at Leeds University have developed "live"
because, they claimed, dental hospital training was            skin, which could mean an end to cosmetics testing on
inferior to the training they had. However, oral               people or animals. The new model, which reacts like
surgeons convinced legislators that it was only fair to        human skin, will enable cosmetics companies to test
let them do elective surgery, saying that they already         their products without the danger of causing irritation
repair faces damaged in car accidents and other                or damage. The skin research team at Leeds University
traumatic incidents.                                           has used skin tissue donated to the Regional Tissue
                                                               Bank in Sheffield, sterilized it and subjected it to tissue
                                                               culture. They removed the epidermis cells and left the
                                                               skeleton structure to get the substance of collagen. The
                                                               collagen fiber was recolonised to receive a piece of
                                                               skin that could be worked on while carrying out
                                                               product tests.

Many long-established skin products, such as
shampoos and soaps, contain harmful or ineffective
ingredients because effective testing methods were               October 9 – 13
unavailable when they were developed.                            Plastic Surgery 2004. The Premier Educational
Until now skin-care products have eventually had to be           Experience Organized by American Society of Plastic
tested on human volunteers, and companies conducting             Surgeons and Plastic Surgery Educational Foundation.
the tests have had no way to predict when a product              Venue: Philadelphia Marriott Hotel, Pennsylvania
would prove dangerous on tested skin.                            Convention Centre
Director of the university's Skin Research Centre, Dr            Tel: +847 228 9900, ext.472
Richard Bojar, said: "The model is a piece of skin that          Email: registration
is not a body part of any human being. It is a tissue-           URL:
engineered piece of skin where you can apply a
compound that kills bacteria. When human skin is used
for testing the process is both expensive and dangerous          October 15 – 17, 2004
as irritation might develop.‖ The research team is to            Advanced Techniques in Upper Extremity
collaborate very soon with a multi-national skin-care            Reconstruction - a Hands-On Cadaver Workshop
company. Dr Bojar said: "The skin construct reacts like          Sponsor: Saint Louis University
human skin and that's why companies might be                     Venue: St. Louis, Missouri, U.S.A.
interested in using it. The difference is that this method       Tel: 1-314-535-4000
is cheaper, safer and quicker."                                  Fax: 1-315-535-8214

FORTHCOMING                                                      November 19 –21, 2004
                                                                 ISSHCON 2004 – Annual Conference of the Indian

EVENTS                                                           Society for Surgery of the Hand
                                                                 Venue: Chintan Bhawan, Gangtok, Sikkim
                                                                 Contact: Dr. Bhaskarananda Kumar
                                                                 Fax: +820 25 70062
CONFERENCES IN 2004 - 05                                         Email:
September 7, 2004
Hand and Wrist Biomechanics Symposium
                                                                 November 23 –27, 2004
Venue: Syracuse, New York, USA
                                                                 APSICON 2004 – 39th Annual Conference of
Contact: Frederick W. Werner, MME
                                                                 Association of Plastic Surgeons of India
Tel: 1-315-464-6468
                                                                 Venue: Birla Auditorium Jaipur
Fax: 1-315-464-6638
                                                                 Contact: Conference Secretariat, 703 Maharani
                                                                 Apartments, B-208 Rajendra Nagar, Bapu Nagar,
                                                                 Jaipur, 320 015
                                                                 Tel: 0141-2701710, 2703940
September 16 – 18, 2004
SICPRE - Società Italiana di chirurgia Plastica                  Email:
Venue: Pisa, Italy                                               URL:
                                                                 November 27 & 28, 2004
September 30 – October 2, 2004
                                                                 Plastic Surgery Master Class on Volumetric Facial
Operative Workshop on Cleft Lip Rhinoplasty
Venue: Department of Plastic Surgery, JIPMER,
                                                                 Coordinator: J. William Little M.D and Bud Alpert M.D
Pondicherry, INDIA
                                                                 Venue: Puka Park Lodge Resort, Coromandel, New Zealand
Contact: Dr. Karoon Agarwal
                                                                 Contact: Tristan de Chalain, Auckland Surgical Centre,
Tel: 0413 2273132 / 09894027313
                                                                 9 St. Mark‘s Road, Remuera, Auckland. New Zealand.
                                                                 Fax: 064 09 522 0435
October 4 – 6, 2004
The 5th Asian Pacific Craniofacial Association
                                                                 November 28 - 30, 2004
                                                                 ISAPS Post Graduate Instructional Course on
Venue: Sheraton Grande Walkerhill, Seoul, South
                                                                 ‘Innovations and Technologies – Tissue
                                                                 Engineering, Body Contouring and Facial
Contact: Dr. Kap-Sung Oh
                                                                 Rejuvenation.’ organized by Indian Association of
                                                                 Aesthetic Plastic Surgeons.

Venue: Jaipur                                               SECRETARIAT
Contact: Dr. Lokesh Kumar
Tel: +91-11-29228349 / 51637288                             Department of Plastic & Reconstr. Surgery
Fax: +91-11-26823629                                        Institute of Medical Sciences, B.H.U.
                                                            VARANASI, INDIA
December 4 – 5, 2004
Craniofacial Surgery & Transfacial Approaches to
the Skull Base
Venue: St. Louis, Missouri, USA                             EDITORIAL OFFICE
Tel: 1-314-535-4000
Fax: 1-314-535-8214                                         Dr. Surajit Bhattacharya
Email:                                      Capital Diagnostics, Mini Plaza, M2 Gole Market
                                                            Mahanagar, LUCKNOW 226006, INDIA
                                                            Tel: 91 522 2384881 / +94150 81668
December 6 – 9, 2004                                        Fax: 91 522 2380550
9th. International Congress of the Oriental Society         Email
of Aesthetic Plastic Surgery.
Venue: Shangri La Hotel, Bangkok, THAILAND
                                                            URL: www
Contact: Dr. Kamol Wattanakrai                    

January 14 – 16, 2004
4th. Annual Congress of Indian Society of Cleft Lip,
Palate and Craniofacial Anomalies
Venue: Hyderabad, India
Contact: Dr. Srinivas Gosla Reddy
Tel: +91-40-55764884 / 27428888
Fax: +91-40-27427492

February 2 – 6, 2004
13th. Annual Conference of National Academy of
Burns – India (NABICON 2005)
Venue: India Habital Centre, Lodhi Colony, New
Contact: Dr. P.S. Bhandari
Tel: +91-11-23231871 / 09810498449
Fax: 91-11-23222756

March 19 –23, 2005
9th Asian Pacific Congress of The International
Confederation of Plastic, Reconstructive and
Aesthetic Surgery
Venue: Taj Mahal Hotel, Mumbai, INDIA
Contact: Dr. Mukund R. Thatte, 9th. Asian Ppacific
Congress Office, Travel Corporation (India) Pvt. Ltd.
Chander Mukhi, Nariman Point, Mumbai 400021.
Tel: +91-22-22021881
Fax: +91-22-22029424


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