Operative treatment of the chronic post-traumatic boutonnière deformity by the technique of pieper.

We report eleven cases of chronic, non-fixed, post-traumatic boutonnière deformity treated by the technique of Pieper: One lateral slip was mobilised and distally desinserted. At the PIP, the slip was pulled through the central slip and sutured in correct tension to the released opposite lateral slip. 73 % regained full extension at the proximal interphalangeal joint. Despite a mild extension deficit of 15 degrees at the distal interphalangeal joint in 64 %, ten of eleven patients were content with the post-operative outcome. We conclude that the technique of Pieper is a good and valuable operative procedure to correct chronic non-fixated button-hole deformity.

[Digital nerve block anaesthesia: historical development and two cases of finger-tip necrosis, a rare complication]. / Fingerblock-Anästhesie - Uber die geschichtliche Entwicklung und zwei Fälle einer Fingernekrose als seltene Komplikation.

Two cases of finger-tip necrosis following digital blocks are presented. These are rare complications of this technique. Pathogenesis and treatment options are discussed and the literature reviewed. Circulatory problems can be avoided by using adrenalin free anaesthetics, infiltrating at the metacarpal level with small volumes, and using upper-arm tourniquets instead of rubber bands at the phalangeal level.

Experience in upper eyelid reconstruction with the Cutler-Beard technique.

Reconstruction of full-thickness upper eyelid defects has to supply a movable lid with perfect corneal protection, good aesthetic quality, and acceptable sequelae at the donor site. The Cutler-Beard procedure, a full-thickness cutaneoconjunctival inferior eyelid advancement flap, is a reliable method for reconstruction of total or partial upper eyelid defects. Especially in older individuals, the skin of the donor site is loose and provides sufficient tissue to stretch. Color and texture of the donor matches the recipient site perfectly. Destabilization or ectropion of the donor site, the lower lid, and retraction or entropion of the recipient site, the upper lid, are the main complications. Therefore, a modification of the classic technique should be considered by implantation of an enforcing inlay in the reconstructed lid (eye bank sclera, fascia lata, ear cartilage), especially in reconstruction of extended defects of the upper lid.

[Distal pedicled sural island flap-plasty for defect coverage of the distal lower extremity]. / Die distal gestielte Suralis-Insellappenplastik zur Defektdeckung an der distalen unteren Extremität.

Soft tissue defects on the distal lower extremity often need extended reconstructive procedures, especially if tendinous, articular, or bony structures are exposed. The use of local flaps in the perimalleolar, pretibial and calcaneal area is limited, often free tissue transfer is required. The distally based sural island flap is a pedicled soft-tissue flap on the vascular axis of the sural nerve. It can be raised as a fasciocutaneous or a lipofascial flap. We report our experience of 16 cases, nine of these cases in the lipofascial technique. The aim of soft tissue coverage was reached in 15 cases. In one patient a partial necrosis of the flap occurred requiring a reoperation with free flap coverage. The main advantages of the technique are the extended arc of rotation in the problematic area of the ankle and the lower extremity, the easy and fast preparation and the stable flap perfusion. The lipofascial as well as the fasciocutaneous flap have some risk of loss or donor-site morbidity that can be avoided by adhering strictly to certain operative principles.