A strategic approach of variable flap selections based on different tongue defects may achieve predictably better functional and aesthetic outcomes. The innovative pentagonal anterolateral thigh myocutaneous flap for total tongue reconstruction creates a free neotongue tip with adequate volume, producing acceptable swallowing function and cosmesis.

Using Herovici staining and digital image analysis, we have studied the collagen subtype and fiber orientation in mature burn scars. These techniques have shown mature burn scars to have increased type I/type III collagen ratios compared with normal skin. Additionally, the collagen orientation of burn scars has been shown to be thickened, tightly packed, and lacking the "basket weave" appearance of normal skin specimens. These techniques allow the differentiation of type I collagen from type III collagen, the assessment of collagen orientation, and the analysis of scar architecture in terms of epidermis and papillary/reticular dermis contribution. These findings are important clinically because collagen subtype and fiber orientation may predict future scar activity. Any attempt to modify the scarring process can be directly measured and compared using this easily reproducible technique.

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Luck (1959) described a histological staging system for Dupuytren's disease, classifying the disease into three stages. Previous biochemical and immunochemical studies have detailed the decrease in type III/I collagen ratio with disease progression. Herovici (1963) described a histological stain that produced a differential red/purple and blue colour for type I and III collagen respectively. We stained 15 specimens of Dupuytren's disease and quantified the different collagen types in each using computer analysis. We found a corresponding decrease in the amount of type III collagen as a percentage of the total collagen with disease progression: stage I range 35-49% (mean 38%); stage 2 range 21-33% (mean 27%) and stage 3 range 11-19% (mean 14%). We propose a new staging system based on the relative amount of type III collagen, where stage 1: >35%, stage 2: >20% and <35%, and stage 3: <20%.