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For a few years new Chondroplast has been available as a ready-to-use product in a variety of different shapes and sizes. The material is obtained from bovine cartilage and is made antigen-free and stable against decomposition by treatment with glutaraldehyde and irradiation. To date we have used Chondroplast for lid stabilization in 9 eyes with very slack entropion or ectropion. For tarsusplasty secondary to tumor resection we chose Chondroplast for seven eyes. A thin 0.5-mm-thick lamella was cut out of the original material and positioned in a preformed pocket between the orbicularis muscle and the skin and conjunctiva and then fixed with Vicryl sutures. Corrective of eyelid malposition was combined with pentagonal excision for ectropion, or resection of the orbicularis muscle for entropion. In plastic lid replacement the material was sutured to the existing wound edges of the lid margin and covered posteriorly with conjunctiva and anteriorly with advancement or transposed flaps. In all patients the implant took well, and there were no complications during wound healing. The cosmetic and functional results were satisfactory. The largest post-operation follow-up time was over 1 year. In one case--1 year after resection of a lower eyelid basalioma--we had the opportunity to examine histologically the tissue in the area of a Chondroplast implant. We performed this biopsy excision because of a suspected recurrence. Macroscopically the implanted cartilage lamella was surrounded by a barely vascularized capsule. Histologically we found a non-vital cartilage implant surrounded by a mainly fibrotic connective tissue capsule. In only a few places was there evidence of a slight reaction to the foreign body but without substantial inflammation activity. There was also no histological indication of resorption of the implant.
Obtaining and maintaining an anatomic reduction are the keystones in the treatment of severe midtarsal injuries to avoid long-term disability. The use of the small external fixator or the minidistractor allows an indirect reduction with careful management of the soft tissues. By leaving the external fixation for at least 8 weeks the important length of the medial and lateral longitudinal arch can be maintained. Further advantages are the postoperative observation of the soft tissues and circulation without cast immobilisation.
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The use of a small trephine for chalazion surgery or tarsal biopsy is described. Over 1,000 cases have been treated in this manner with minimal recurrences and complications.
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Severe soft tissue injury occurring in sprains and dislocations may lead to painful disability after plaster-immobilisation for 6-12 weeks. Therefore, primary operation is indicated for ligamentous repair, osteochondral fracture-fixation and internal K-wire stabilization of dislocations after reduction. After 1 week of immobilisation, the patient should begin active daily muscle exercises; in the 2nd week patients are mobilized with support of a dynamic, partial weight-bearing splint, allowing continued muscle exercises until weight-bearing is possible 6-8 weeks after surgery. In 23 patients undergoing operations for acute dislocations excellent results were obtained in 14 (60%) and fair results in 7 (30%), while two patients (10%) had to have legs amputated because of arterial thrombosis and vascular disease.
In the anophthalmic socket, the deep superior eyelid sulcus is a quite common syndrome; sometimes with ptosis of the upper eyelid and laxity of the lower eyelid. The treatment by a silicone prosthesis in the deep sulcus fills eyelid volume. The main advantages of this procedure are simplicity and relative harmlessness. The authors relate their technique and the results about 15 cases. The indications are discussed.
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The authors have studied 18 cases of patients presenting podiatric disorders as well as a moderate varicose or lymphatic involvement. The functional symptomatology, dominated by antero-lateral leg pain, was important enough to disturb professional or leisure activities. By preferring the study of walking abnormalities (varus effect, dominant varus or equal varus-valgus instability) and the search for an elective involvement of the lateral peroneus brevis, an accurate podiatric diagnosis was made along with its ensuing therapy: adequate fitting of shoes and prescription of well adjusted ortheses which correct a dynamic hollow foot. With this treatment, the functional disorders were regularly improved or they disappeared. This result could not have been obtained by treating only the vascular impairment, which was treated conjointly in function of its own indications which do not appear to be modified by the podiatric evaluation.
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