[The sliding technique : a precise method for treating the overprojected nasal tip]. / Die Sliding-Technik : Eine präzise Methode zur Korrektur der überprojizierten Nasenspitze.

BACKGROUND: The aim of the present report is to demonstrate the sliding technique as a reliable and exact method to treat the overprojected nasal tip. METHODS: Between March 2003 and April 2008 we treated 271 patients (198 females, 73 males) using the sliding technique for isolated tip hypertrophy (n=88), rhinomegaly (n=146), asymmetry of the nasal tip (n=29) and ptosis with malformation of the alar cartilages (n=8). RESULTS: Medial sliding was performed in 100 patients, lateral sliding in 121 patients, and combined lateral and medial sliding in 12 patients. In total, 18 patients needed additional skin resection at the columella. After an average follow-up period of 8.4 months 77.1% of the patients (n=209) rated the result as "very good", 21.1% (n=57) as"good" and 1.8% (n=5) patients were"unsatisfied". Only 1.8% (n=5) had to be revised due to nasal tip projection. A retrospective study of our first 80 patients showed an average reduction in projection of around 11%. CONCLUSION: The sliding technique is a precise and effective method to treat the overprojected nasal tip.

[Overresection of the lower lateral cartilage. A frequent cause for revision rhinoplasty]. / Ausgedehnte Resektion der Flügelknorpel. Häufige Ursache für Revisionen nach Rhinoplastiken.

BACKGROUND: Overresection of the lower lateral cartilages to narrow the tip may give rise to a dysfunction of the external nasal valve and aesthetic deformities like alar pinching, alar retraction, tip asymmetry, lack of tip definition and projection, leading to parrot beak deformities resulting from drooping of the tip. PATIENTS AND METHODS: Between 1998 and March 2008 we performed 1670 secondary rhinoplasties on patients who had undergone previous surgery elsewhere. The lower lateral cartilages where found to be missing in 89 patients intraoperatively. It was necessary to rebuild the structure of the nasal framework in order to resolve the deformities. We prefer to use septal cartilage or, if unavailable, costal or auricular cartilage. The deformities were analysed pre- and postoperatively by the operator based on clinical evaluation and standardised photographs. Patient satisfaction was evaluated subjectively. RESULTS: The postoperative results as judged by the surgeon showed a clear improvement in tip definition (100%) and projection (100%), alar pinching (100%), tip deformities (95.2%), tip deviation (77.8%) alar retraction (87.5%) and tip ptosis (85.7%). The function of the external nasal valve as evaluated by the surgeon was completely restored in all cases (100%). The average follow-up period was 13 months. In all, 50 patients (59.6%) stated that the result was "excellent", 28 (33.3%) as "very good", five (5.9%) as "good" and one as "not satisfied" (1.2%). CONCLUSION: In the case of destroyed anatomical structures we completely rebuild the structure of the nasal tip, since only a correct anatomical configuration correlates with ideal aesthetics and physiological function.

[Painful soft-tissue swelling of the upper arm]. / Schmerzhafte Weichteilschwellung am Oberarm.

Cat-scratch disease is an infection by Bartonella henselea and resolves spontaneously. We present a case of untypical Bartonella infection which was misinterpreted by MRI as a soft-tissue sarcoma of the upper arm. The histological findings of an incision biopsy were unspecific, without signs of malignancy. The tumor was excised completely and the final histology, however, showed no evidence of malignant changes. The Bartonella henselae infection could be confirmed by polymerase chain reaction. The untypical presentation of cat-scratch disease should be considered in the differential diagnosis of clinically suspected soft tissue sarcoma.

[Carpo-metacarpal dislocation injuries]. / Karpometakarpale Luxationsverletzungen.

Carpometacarpal dislocations are rare. In most cases, the dislocation is caused by a violent injury, e.g. the crash of a motorcyclist or a fall from great height. A considerable swelling of the back of the hand may mask the characteristic lump at the root of the hand. The diagnosis can be easily missed due to serious associated injuries. The lesion is also often overlooked in the routine X-ray diagnostic. Lateral and oblique views are important for the recognition of the true extent of the lesion. Anatomical reposition is difficult if the dislocation is not fresh and open reposition is necessary. Between 1990 and 1999, altogether 16 patients who had suffered a carpometacarpal dislocation were treated. One patient had a rare dislocation of the III. to V. joints. Simultaneous dislocation of all five carpometacarpal joints was seen in three cases. The treatment mostly consists of closed reduction and temporary Kirschner wire transfixation. Fourteen patients were controlled (clinical examination and X-ray control) after an average follow-up time of three years. In addition, the DASH questionnaire was used. After an average time of 3 years the patients showed in 64% of the cases excellent and good results (eight excellent, one good). The subjective function of the hand was moderate in 29% (four patients), in one patient the subjective function was poor (7%). Five patients had a diminished range of motion of the hand. The average points in the DASH questionnaire were 24. We recommend as therapy of choice after primary closed repositioning, primary surgery by means of short Kirschner wires introduced from distal-dorsal to proximal-palmar. In cases of impossible closed reduction or in cases with local additional injuries, open treatment for fixation, is indicated.