Ear cartilage grafts to the nose.

We present our experience in the treatment of secondary nasal deformities caused by excessive resection of the nasal dorsum. We have used ear cartilage autografts, with good results and (on the whole) little or no resorption (some have been followed for 10 years). We consider it essential to correctly shape the transplant and to hold it firmly in the proper position for a period of not less than one week.     

Lengthening the foreshortened nose

The surgically shortened nose is an infrequent but distressing problem that is difficult to repair. This article describes a simple technique to lengthen the nasal profile with a triple-stacked tip graft placed caudal to the medial crura. Fifteen patients have been operated on, and most were undergoing face lifts. The skin inelasticity in older patients allows easy skin redraping over the larger tip volume.     

Femoral Tibial Bypass Grafts: The Alternative to Amputation

Severe ischemia and distal gangrene of lower extremities due to obstruction of the popliteal artery and its branches need not require major amputation. Autogenous vein grafts to the distal anterior tibial, posterior tibial, peroneal and dorsalis pedis arteries can avoid tissue loss in many instances.     

A silicone template to facilitate cartilage grafting in the nose

Silicone sheeting that has the thickness and consistency of septal cartilage for use as a template has been developed to facilitate cartilage grafting in the nose. This technique makes it easier to determine whether or not a graft will correct the deformity and how much autogenous material will be needed before the donor site is harvested. It also allows for more accuracy in the sizing and positioning of the grafts.     

Cartilage of the exterior nose

The cartilages of the nose have been measured on 30 head-halves. The overlap-areas of the lateral nasal cartilages are also estimated. Some angles of the cartilages are included.     

Straightening the twisted nose.

For correction of the twisted nose, the use of a dorsal onlay cartilage graft, obtained from the resected septum, produces the illusion of a straight nose. This persists in spite of any recurrences of deviations in the septum or upper lateral cartilages.     

Management of the bulbous nose

"Bulbous nose" is a term patients often use to describe a "ball" on the end of their nose. This ball can be caused by the abnormal anatomy of alar cartilage or by the overlying soft-tissue coverage. The purpose of this article is to analyze the different causes of bulbous noses and their treatment options. An analysis was done based on four decades of experience and long-term follow-up. We included 10 patients for our discussion. The relationship of the tip to the vault must be analyzed, because it can create optical illusions. For instance, a low bridge makes the tip appear larger; therefore, a bulbous nose may be relative. Similarly, excessive narrowing of the nasal base by alar wedges makes the tip appear wider. Intrinsic causes of a bulbous nose include skin, subcutaneous tissue (including the nasal superficial musculoaponeurotic system, ligaments, and fat), and the shape and direction of the individual crus. Nasal skin varies as to volume and ability to contract; therefore, the shape, direction, or divergence of the individual crura cannot undergo unlimited modifications. There are several surgical possibilities for a given problem. Making the diagnosis of the underlying abnormal anatomy is the most important step; then the most appropriate operation can be selected. Struts, sutures, resection, dome division, and/or dorsal augmentation are all viable options for the management of the bulbous nose.