Hypoplasia of the lower medial quadrant of the breast.

A corrective surgical technique is described for a newly defined deformity: hypoplasia of the lower medial quadrant of the breast. It involves reducing the usually enlarged nipple-areola complex and reshaping the breast by turning a glandular pedicled flap from the fairly large upper two quadrants on a medial base into the underdeveloped site of the medial lower quadrant. The method proved uniformly successful in 11 cases and 17 breasts involved.

[Long-term results following implantation of breast prosthesis with a polyurethane coating]. / Langzeitergebnisse nach Implantation von Brustprothesen mit einem Polyurethanüberzug.

42 of 63 cases of bilateral augmentation mammaplasty using polyurethane-covered prostheses, so-called Ashley "Natural-Y" prostheses were seen 15 to 17 years after the primary operation. Two implants had previously been replaced by Cronin gel type prostheses for various reasons. The 84 breasts which were examined in follow-up compared well with breasts augmented with other devices as far as capsular contracture was concerned. The extreme difficulty of removing these implants because of the deterioration of the polyurethane cover makes any further use of these implants unjustifiable.

Long-term results of polyurethane-covered prostheses.

Forty two of 63 cases of bilateral augmentation mammaplasty are surveyed in which the so-called Ashley "Natural-Y" polyurethane-covered prosthesis was used. The cases were evaluated 15-17 years after the primary operation. These cases were compared with breasts augmented with other devices with respect to capsular contracture. The extreme difficulty of removing these implants because of the deterioration of the polyurethane cover leads the author to conclude that any further use of these implants is unjustifiable.

[Pigmented neurofibroma]. / Pigmentiertes Neurofibrom.

In a 24-year-old male melanin synthesis was demonstrated in a neurofibroma by light and electron microscopy. Although it is unclear whether the tumor cells are pigment-synthesizing Schwann cells or whether they originate from a coexisting melanocytic tumor, this tumor again demonstrates the close relationship between peripheral nerve sheath tumors and melanocytic malformations, as for example cellular blue nevi.

[Secondary rhinoplasty]. / Die sekundäre Nasenplastik.

A personal experience of 1199 cases of secondary rhinoplasty with an analysis of possible mistakes is attempted. Avoidable and partly avoidable complications are listed. The surgical and psychological aspects are discussed and the therapeutic consequences outlined. Typical cases to illustrate these principles are presented.

[An extremely long Abbé flap for simultaneous reconstruction of a defect of the upper lip and the columella]. / Der überlange Abbé-Lappen zur simultanen Rekonstruktion eines Defektes im Bereiche der Oberlippe und der Columella.

X-ray treatment of a small haemangioma of the upper lip in a child led to severe health consequences, about 20 years later. Besides an extremely hypoplastic upper lip with whistle tip deformity, an exulcerated basal-cell carcinoma had developed upon the columella and the lower part of the nasal tip. The goal of the operation was to perform a radical excision of the tumor but also to obtain an aesthetically pleasing reconstruction of the upper lip and a simultaneous covering of the defect, resulting from the tumor excision on the columella and the nasal tip. To achieve this, we have chosen an Abbé-flap, with an extremely long cutaneous pedicle. While in Abbé-flaps the relation between muscular and cutaneous part usually is about 1:2, in this case it was about 1:5. With this flap it was possible to cover in one stage the defect in the upper lip, the columella and the nasal tip.

Fibrin tissue adhesion and its use in rhytidectomy: a pilot study.

In a series of 82 consecutive personal cases of rhytidectomy, a two-component tissue adhesive was used to glue the cheek-skin down to its underlying tissues. The use of most of the sutures in front of the ear, in the visible area, could be spared by this technique. The diminished (or absent) postoperative swelling and the reduction of secretion in the first 24 hours were most impressive. Some operating time can be saved as well and the comfort of the patient is remarkably increased over the healing period. Postoperative complications were entirely absent and the primary results most pleasing. Nothing can as yet be said regarding long-term results, since the time of 18 months is too short for any such statement. The comparatively small additional costs incurred seem very much worthwhile for these selective operations.

[Long term results after funnel chest reconstruction (author's transl)]. / Langzeitresultate nach Trichterbrustkorrektur.

The results of 25 funnel chest operations are reported. All patients have been treated by a modified Ravitch method. Fixation of the anterior chest wall was achieved by inserting two metal wires. Cosmetic and functional results were critically examined postoperatively. For clinical assessment the cardiorespiratory and ergometric tests were analysed. Cosmetic results were graded by the classification of Hecker. All patients showed a very good cosmetic result. The functional situation could be improved only partially.

[Reconstruction of major chest wall defects by a latissimus dorsi myocutaneous flap and autologous dermis graft (author's transl)]. / Verwendung eines Latissimus-dorsi-hautmuskellappens und autologer Dermis zur Rekonstruktion grosser Thoraxwanddefekte.

In a case of breast cancer which infiltrated the anterior chest wall parts of the 4.-8. rib have to be resected. The defect of the chest wall measured 24 x 14 cm and was covered in two layers. By inserting an autologous dermis transplantant in the bony defect tightness and stability of the chestwall was achieved. The myocutaneous defect was covered by a latissimus dorsi island flap. Using this technique a perfect healing of the dermis graft was guaranteed.

[Thoracic wall reconstruction using autologous skin flaps and lyophilized dura: a comparative long-term study in dogs]. / Thoraxwandrekonstruktion mit autologem Dermislappen und lyophilisierter Dura: Eine vergleichende Langzeitstudie beim Hund.

In an experimental study in dogs a defect in the chestwall was created by resecting two ribs on each side. The defect then was replaced by lyophilized dura and free dermis transplants. In X-ray observations and tissue examinations both materials are evaluated by comparing the results. After one year both graft materials showed identical results concerning function and tissue compatibility. Both, dura and dermis were totally resorbed replaced by collagen and connective tissue.

The use of an intraoperative molding device for the reconstruction of a female breast after mastectomy.

A temporary intraoperative molding device for the reconstruction of a breast after mastectomy is presented. It is a low-cost, throw-away Silastic rubber product. It follows the principle of a tailor's wooden model, to allow an easier forming of a breast.

[Asteroid plastic surgery as optimum management of complete and partial vaginal occlusion (author's transl)]. / Die Sternplastik als optimale Therapieform des kompletten und inkompletten Scheidenverschlusses

Opinions differ about the type of surgical procedure to be applied in cases of complete or partial vaginal occlusion. The large percentage of postoperative vaginal stenoses and functional disorders necessitated a search for a new technique. The mucous membrane of the introitus vaginae is incised in the shape of a lying cross and the four flaps thus made are detached. Then an exactly lateral incision is made on each side of the crossing point described above resulting in a broad access to the vagina. Once the opening is wide enough, a second group of triangular flaps is formed vertically to this horizontal incision; the dimensions of the triangular flaps in the inner and outer group must be identical. Then the outer four flaps are turned inward and the four inner flaps are turned outward and interlinked so that a zig-zag line is formed which encircles the vagina in the area of the former stenosis. Thus far this surgical technique has been applied five times and yielded satisfactory results in every instance.