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After primary tenoraphy of flexor tendons one often finds a hampered function of the DIP-joint. Analysis of the pattern of early mobilization exercised by our patients in the Kleinert splint and analysis of the excursions of the flexor tendons of fresh unembalmed specimens brought us to the conclusion that the Kleinert dynamic splint fails in maintaining a sliding movement of the deep and the superficial flexor tendons along each other because the splint excludes motion at the distal interphalangeal joint. Based on our observations we modified the Kleinert dynamic splint. Our experience with 37 patients shows that this modified splint gives a better function in the DIP-joint.

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Using a relatively simple test, breaking pressures of 50 gel-filled breast implants that had to be removed have been evaluated. These pressures values were compared with forces generated in executing closed capsulotomy (nutcracker method). It is shown that there is a negative correlation between pressure resistance of breast implants and duration of implantation. After an implantation time of more than five years, our advice is to perform closed capsulotomy if done in a very gentle way, and implant rupture then certainly has to be taken into account.

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In this paper, the subject of surface-area gain in tissue expansion is approached from three sides. With the help of a mathematical approach, the theoretical increase in surface area was calculated in relation to the specifications of the expanders. In an in vitro model, these mathematical data were confirmed to be reliable. To determine the real surface-area gain that takes place in vivo, measurements on pigs were performed. It appears that only about 35 percent of the mathematically expected increase in surface area takes place. Moreover, a clear difference was observed between the surface-area gain for the different shapes of tissue expanders.

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The operative management of pressure sores in the ischial, sacral and trochanteric region is based on the gluteus maximus muscle and its vascularization. Pressure sores in the sacral region were closed with eleven V-Y musculocutaneous flaps, for the ischial region with fifteen pendulum flaps, and for the trochanteric region with eight medial thigh flaps. In the four years follow-up of 24 patients three recurrences occurred and the post-operative morbidity was acceptable. The operative technique and the complications are further discussed.

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Idiopathic calcinosis of the scrotum is a rare disease that may cause massive deformation of the scrotal wall. The first patient we present was also known to have neurofibromatosis. In the second patient we describe, nodules of idiopathic calcinosis of the scrotum were seen with walls that evidenced no epithelial lining, as well as calcification in epithelial cysts. At present, the only possible treatment is excision, and we excised the afflicted skin without problems in primary wound closure.

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Following severe trauma to the middle third of the face, a common deformity requiring secondary correction is a combination of lowered orbital floor and enophthalmos often associated with diplopia and ptosis. Silicone discs are used to elevate the orbital floor and silicone beads inserted subperiosteally to correct the enophthalmos. In a series of 44 cases we have had no instance of infection or rejection although some beads had to be removed in 1 patient because of increased pressure on the eye. Close collaboration between plastic and ophthalmic surgeons is essential.

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After a severe trauma of the face, e.g. fractures involving the zygoma, the upper jaw or other orbital bone alteraions and deviations of the bony orbital contours and also of the orbital contents can subsist, even after primary operative correction. The patients have functional as well as cosmetic complaints. In consequence of eyeball dislocation and incarceration or fibrosis of the external eye muscles, the patients also complain of diplopia in one or more directions. Due to the bony orbit enlargement and reduction of the orbtial contents, the eye is moved inferiorly and backwards, also causing diplopia, ptosis and a deep sulcus of the upper lid. The treatment consists in closing and sufficient raising of the orbital floor correction of the enophthalmos. To cover the floor fracture, we apply 1-8 perforated Teflon implants which are placed under the periost of the orbital floor. To correct the enophthalmos, we use 30-50 Teflon beads with a diameter of 5 mm, and placed them in a sub-periorbital pocket laterally above and behind the eyeball, thus ensuring that the eye will be forced forwards in the cone-shaped orbit and so diminish or eliminate the enophthalmos. The operation is performed in close cooperation between an ophthalmologist and a plastic surgeon. Most of our cases also needed operative muscle correction. Although not all deviations could be totally corrected, we always achieved a clear improvement, and all 36 patients obtained a useful field of binocular single view. Until now we have had no implant infections or rejections. We should like to consider that this method of correction will have its own place in the treatment of orbital deformities.

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