Segmental bone and cartilage reconstruction of major nasal dorsal defects.

This article describes the results of segmental bone and cartilage reconstruction of significant nasal dorsal defects. Solid bone graft reconstructions frequently lead to an unnatural hardness of the nasal tip. Rib cartilage reconstructions are pliable and soft but are a problem because they easily undergo warpage. The operation is performed using the open approach. Outer cranial bone graft is used for the bone component and extends at least two-thirds of the length of the dorsum. It is secured in place with a compression screw and a Kirschner wire. The cartilage component consists of an abbreviated L strut constructed of septal or conchal cartilage. It is slotted into the cranial bone in a tongue-in-groove manner and is sutured to it through a drill hole in the bone. The dorsal profile is completed with a single cartilage onlay graft or multiple sagittal cartilage grafts secured to the sides of the L strut. Twelve patients underwent segmental reconstruction of nasal deformities. Within this group, five patients underwent secondary rhinoplasty, five underwent posttraumatic rhinoplasty, and two underwent nose augmentation for Oriental features. There were seven men and five women. In all cases, good nasal tip mobility was maintained, and the nasal tips were soft. The interface between the bone graft and cartilage graftwas well camouflaged. The two did not separate. This procedure follows the principle of replacing lost tissue with like materials.

Combined conchal cartilage-ethmoid bone grafts in nasal surgery.

Septal cartilage grafts are frequently required in rhinoplasties and nasal reconstructions. Unfortunately, sufficient septum is not always available for graft purposes. Conchal cartilage can serve as a substitute, but its usefulness is limited because of its soft, elastic nature. Applying thin sheets of pliable ethmoid bone to conchal cartilage gives the cartilage greater strength and, at the same time, allows it to retain some flexibility. This article examines the role of combined conchal cartilage-ethmoid bone grafts in nasal surgery. These grafts are simple to construct and are versatile in their application. By maintaining a free cartilage edge, they are readily sutured into place. The results seem to last long term.

Suture correction of nasal tip cartilage concavities.

This paper describes a suture technique to correct nasal tip cartilage concavities. Exposure is through an open rhinoplasty or cartilage delivery technique. The concave cartilage is tented upward from inside the nose to the desired contour. Interlocking mattress sutures are then inserted in a chain-link fashion to hold the cartilage in position. Each stitch creates a miniature convexity, and the combined linkages form the complete convex arch. Three tension-control sutures are usually required. The technique was applied in 15 patients with alar cartilage concavities. Four types of cartilage involvement are described: the lateral crus and lateral dome (2 patients), the lateral crus alone (5 patients), the medial dome region (2 patients), and the lateral dome region (6 patients). Two case examples are presented. There has been no loss of correction in follow-up examinations ranging from 9 to 26 months.

Profundus tendon blockage: quadriga in finger amputations.

After finger amputations, spontaneous adhesions of the resected profundus tendon may occur in the finger stump or palm. Because of the normal interconnections of the profundus tendons, such adhesions can block the excursion of the profundus tendons to intact fingers, resulting in the quadriga syndrome, or profundus tendon blockage. This causes a decrease in the power and range of movement of the terminal joints of the uninjured fingers when they are fully flexed. Three degrees of severity of this weakness are described. The findings and results of surgery in 20 patients demonstrate that the condition is surgically correctable by release of the adherent profundus tendon of the amputated digit. Full active flexion and extension of the intact fingers in the early postoperative period after primary amputation should prevent them from developing profundus tendon blockage.

Limberg-latissimus dorsi myocutaneous flap for closure of myelomeningocele.

A method is presented in which two well-recognized plastic surgical flap techniques are coupled; the Limberg rhomboid transposition flap and the latissimus dorsi myocutaneous flap. The technique was used in 2 patients to provide ample, innervated, and well-vascularized skin cover over myelomeningocele defects.