Understanding Approaches to the Dorsal Hump

Dorsal hump reduction is a central component of western aesthetic rhinoplasty. Surgical success begins with knowledge of aesthetic ideals and accurate preoperative analysis. Knowledge of the patient's distortion from aesthetic ideals informs approach, technique, and instrument selection. Both endonasal and external approaches are suitable for dorsal hump reduction, though the latter affords more versatility when other surgical modifications are necessary. The main techniques consist of en bloc, Skoog, and component resection. Each has their distinct advantage, though a surgeon's comfort level with each should impact technique selection. Completion of the dorsal reduction often leaves a defect that must be reconstructed. Failure to anticipate the potential long-term sequelae and appropriately manage the dorsal defect can lead to a poor result and patient dissatisfaction.

Sagittal Rotational Malunions of the Distal Radius: The Role of Pure Derotational Osteotomy

Sagittal rotational malunion after distal radius fractures was identified in eight patients by the presence of a “hinge” point on the volar cortex on the lateral radiograph, and the ulnar head being shorter than the anterior lip of the radius on the posterior–anterior radiograph. The surgical correction consisted of preplating the distal fragment with a volar locking plate before an osteotomy through the “hinge” point, and correcting the dorsal tilt of the distal fragment. Any dorsal defect was filled with cancellous bone graft from the olecranon. Pain, range of motion and grip all improved. Disabilities of arm, shoulder and hand score changed from 54 to six. Dorsal sagittal tilt improved by 26°, from −23°to +3°. Ulnar variance improved by 3 mm, from +1.5 to −1.5 mm, becoming identical to the opposite side. A pure derotational osteotomy corrected the apparent shortening of the radius and restored the volar tilt.

The “Open Book” Flap: A Heterodigital Cross-Finger Skin Flap and Adipofascial Flap for Coverage of a Circumferential Soft Tissue Defect of a Digit

A case of circumferential digital skin loss with exposed tendons from the proximal phalanx to the distal interphalangeal joint is presented. This was treated with a two-layer heterodigital cross-finger (“open book”) flap from the adjacent digit, utilising a skin-only cross-finger flap to cover the palmar defect and an adipofascial flap to cover the dorsal defect.