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We analysed the records of 25 patients who had their upper lips reconstructed after resection of a tumour. All the repairs were done with triangular cutaneous and musculocutaneous flaps with a skin island with V-Y advancement, and a subcutaneous or muscular pedicle with or without mucosa. The choice of flap was based on the width of the defect after the tumour had been resected. A subcutaneous pedicled flap was used in 14 patients; a musculocutaneous flap not including the mucosa in 5, and including the mucosa in 6. This flap can be used to repair upper lip defects of any thickness. The procedure is quite safe from a circulatory point of view and the flap has the advantage of requiring only one procedure. It is aesthetically satisfactory in most patients and maintains the good function and sensitivity of the lip.

Serologic studies are consistent with our patient's having a single IgM cold autoantibody with IT and P specificities (anti-ITP) and requiring both specificities on the same RBC to permit maximal antibody expression.

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A 54 y.o. woman presented with acute Coombs-negative hemolytic anemia at an outside hospital where she received 25 RBC transfusions and did not respond to prednisone or splenectomy. On transfer to our hospital, routine DAT and IAT were weakly positive, occasionally negative. When a modified "cold" antiglobulin test was employed, the result was strongly positive for IgG, weakly positive for C3d. Cold agglutinin titer was 32, and the Donath-Landsteiner test was negative. The autoantibody exhibited Pra specificity. The patient failed IV-IgG, high dose IV pulse steroids and cyclophosphamide, and continued to require daily transfusions. She responded 21 days after receiving daily plasma exchange (x3), with pulse cyclophosphamide on the third day, followed by escalating daily oral cyclophosphamide.

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