Die erweiterte Nahttechnik zur Korrektur abstehender Ohren

Protruding ears are found as a minor ear abnormality in approximately 5?% of the German population. Apart from being aesthetically displeasing protruding ears are a frequent source of ridicule in children who can subsequently have psychological problems. The surgical treatment of protruding ears can be divided into three standard techniques: the suture technique, the cutting and scoring technique and the cutting and suture technique. The large number of well over 100 modifications described indicates that there is obviously no single ideal technique capable of solving all problems associated with protruding ears. This article describes our approach, which has proven to be successful in correcting all problems of typical protruding ears. On the one hand the apparently advantageous steps of the standard techniques described are used and on the other hand adequate amendments are made in order to avoid characteristic pitfalls and complications.     

Einfaches Verfahren zur Behandlung abstehender Ohren

Although not a medical condition, protruding ears can be disturbing to the extent that they cause social problems for affected individuals. It is well known that their correction can significantly improve the psychological condition of the patient. Several otoplasty techniques have been developed for the correction of this deformity. We present our experience with a minimally invasive suture technique using percutaneous insertion of permanent clear nylon sutures to reshape the deformed auricular cartilage. We have applied this technique in 68 auricles with a high satisfaction rate. The following minor complications occurred: superficial stitch infection in two patients, both of whom required substitution of one stitch, and a palpable knot in seven other patients. The advantages of this technique include that it is a minimally invasive procedure without scarring, it is easy to perform, the auricles look natural, it is associated with only minor pain, there is less risk of extended cartilage infection, and the recovery time is minimal.     

Die Schnittmethode bei der Otoplastik

As an alternative to the commonly used techniques of scratching, partial incision and sutures to correct protruding ears, a method based solely on incisions is explained here. The described method offers the surgeon more options with one technique to deal with a multitude of auricular malformations.     

Die „Ludloff“-Osteotomie zur Korrektur der Hallux-valgus-Deformität

OBJECTIVE: Correction of a symptomatic hallux valgus deformity. INDICATIONS: A hallux valgus deformity in which the intermetatarsal angle I-II exceeds 15 degrees and the shaft of the first metatarsal is broad enough to allow a rotational osteotomy. CONTRAINDICATIONS: Hypermobility of the first ray. Severe osteoporosis. Degenerative arthritis of the first metatarsophalangeal joint. SURGICAL TECHNIQUE: Longitudinal incision over the first intermetatarsal space. Division of the metatarsosesamoid ligament together with the tendon of the adductor hallucis muscle. Opening of the lateral articular capsule of the first metatarsophalangeal joint allowing a tension-free realignment of the head of the first metatarsal with the sesamoids. Medial longitudinal incision along the first metatarsal starting over the medial cuneiform bone and ending at the proximal phalanx of the great toe. Oblique osteotomy of the proximal two thirds of the first metatarsal in a proximal dorsal to distal plantar direction and lateral rotation of the distal fragment around a proximally placed 3-mm AO screw. Additional fixation with one BOLD screw. Trimming of the protruding bone and of bunion. Medial metatarsophalangeal capsulorraphy. RESULTS: Between September 1998 and October 1999, 76 feet underwent a Ludloff osteotomy. Patients were followed up clinically and radiographically for 36 months (24-56 months). The mean hallux valgus angle was reduced from 37 degrees to 14 degrees and the mean intermetatarsal angle I-II from 18 degrees to 9 degrees. Using a four-point scale 81% of the patients were satisfied or very satisfied with the result of the operation. 95% of them felt no or very mild pain.     

Die Korrektur verformter Ohrmuscheln beim Neugeborenen

Ear taping is a simple non-surgical technique to correct ear deformities in newborns. Intuitively this technique is requested by parents of children with congenital ear deformities. Surprisingly this technique is ignored by the majority of physicians. This article describes the technique of targeted taping which should be initiated in the first 3 weeks of life and adapted to the individual circumstances. The targeted influence on the direction of action of the tapes and the necessity for using cotton wool pads play important roles in order to achieve a good result.     

Eine neue Reimplantationsmethode zur Korrektur der Sattelnase

Ohne Zusammenfassung Mit 4 Textabbildungen in 7 Einzeldarstellungen     

Die einzeitige Korrektur skrotaler und perinealer Hypospadien

Delayed correction of genital malformations can have a negative influence on the emotional, psychosocial and cognitive development. Early one-stage-correction to give as near-normal an appearance and function as possible is therefore desirable. This can now be realized in most forms of hypospadias. However, in the rare and most severe forms (5-6%; scrotal and perineal forms) this is technically very demanding. It is extremely difficult for a surgeon to accumulate enough relevant experience, so that one-stage correction is performed only by very few. To investigate results with one-step correction, 100 of 163 cases treated up to 2006 were analyzed. Analysis of the first group of 50 consecutive cases operated on between 1996 and 2001 showed a complication/reoperation rate of 22% (11 cases). The 11 children required a total of 18 (36%) corrective surgical interventions. In 42 cases buccal mucosa was used as a tube onlay. In this group one- stage correction was successful in 39 (78%); 4 patients required two operations and 7 three. Children in group II were consecutive patients operated on between 2003 and 2006. In this group there was a reoperation rate of 12% (6 cases, in 1 of which severe lack of skin made one-stage correction technically impossible). In 45 cases buccal mucosa was used for a tube-onlay. Thus, in group II 44 patients (88%) underwent successful one-stage correction and 6 had two operations; none had three. The significantly lower complication rate in group II is presumably due to greater experience of the surgeons. All strictures observed developed at the level of the glans. In no case was buccal mucosa rejected; nor did any strictures develop between urethra and neo-urethra, being reliably prevented by the connection, with an onlay, to the recessed urethral plate. None of the 100 children became a 'hypospadias cripple'; in all cases satisfactory correction was ultimately achieved. This means that with growing experience one-stage correction can be increasingly reliably achieved. This is not a general call for one-stage correction, but an appeal for patients with these most severe forms of hypospadias to be treated only in specialized centers with the aim of allowing experience to accumulate there so that the results become more reliable.     

Die operative Korrektur des echten Talus verticalis

Operationsziel   

Beseitigung der Skelettdeformität sowie des muskulären Ungleichgewichts zur Verbesserung der Form und Funktion des Fußes sowie der Gebrauchsfähigkeit der Gliedmaße.