[Defect coverage with a bilobed flap with reference to special aspects regarding the nose]. / Defektdeckung mit einem zweizipfeligen Lappen unter Berücksichtigung spezieller Aspekte der Nase.

Defects at the dorsum or tip of the nose are a special challenge for plastic surgeons. Considering the tough skin, primary closure is normally not possible. As full-thickness skin grafts are not satisfactory, we strive for defect-coverage using adjacent skin. One possibility is the bilobed flap which can be used all over the body. Indications, special planning, and technique as well as several variations of the bilobed flap in the nasal region are discussed.

[Management of lateral type B malleolar fracture with penetrating wires, cerclage and hemicerclage]. / Versorgung der lateralen Malleolarfraktur Typ B mit Spickdrähten, Cerclagen und Hemicerclagen.

In this retrospective study 52 cases of malleolar fractures type B, that were treated with Kirschner wires, cerclages and hemicerclages, between 1981 and 1991 at the Männedorf Hospital, were compiled and completed with the corresponding synopsis. The results show that the osteosynthesis technique, in certain cases, is absolutely justifiable and represents a reliable alternative to tensile screw osteosynthesis. This procedure of osteosynthesis is a good method in comminuted fractures as well as osteoporotic bone, in which the screws grip badly. A minimum of osteosynthesis material is implanted in precarious soft tissue conditions. As in the tensile screw osteosynthesis, the removal of the material can be done ambulatory under local anaesthetic with stab incision. The functional after-treatment is not recommended. We suggested a postoperative plaster of Paris treatment for 6 weeks (2 weeks without and 4 weeks with strain). As the postoperative course shows comparable results, osteosynthesis of the lateral malleolar fracture type B with Kirschner wires, cerclages and hemicerclages represents a good variation to plate osteosynthesis and tensile screw osteosynthesis.