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Forty-six patients (fifty hands) had replacement of the trapezium by a silicone implant that incorporated a local tendon strip to stabilize the device. The patients had intractable pain due to degenerative changes of multiple facets of the trapezium. The over-all rate of subluxation and dislocation was 10 per cent. In all hands, pain-free improved movement resulted. The pinch strength approximated the normal, averaging six kilograms for women and eight kilograms for men.

We successfully closed the isolated patent ductus arteriosus in 58 of 61 consecutive patients using the transfemoral-catheter method originally introduced by Porstmann in 1968. To perform this technique more safely and reliably, some instrumental and technical improvements were made. The indications for this method have been expanded to include the cylindrical or window-type ductus as well as the conical-shaped ductus. Classification into three groups of the configuration of the ductus by angiography has been useful in selecting the shape of the closing plug. Whenever feasible, we consider the catheter technique to be the method of choice to close the ductus.

General and special problems of keratoprosthetics are discussed with regard to experineces obtained from 38 prosthetic Cardona operations on 32 patients.

Experimental studies in rats and bulls demonstrated the feasibility of using a silicone-Dacron prosthesis as a sperm reservoir in cases of excretory azoospermia. In the study of bulls, 50% of the cows inseminated with spermatozoa aspirated from the alloplastic spermatocele conceived and delivered healthy calves. The clinical results of a series of 14 humans suffering from excretory azoospermia not treatable by other means (e.g., epididymovasostomy or vasovasostomy) also are presented. THe aspirations from these spermatoceles produced motile spermatozoa; however, none of the patients'p spouses conceived after insemination.

A new simple method of treating urinary stress incontinence is to fix a fibrin implant vaginally to the bladder neck and upper urethra. The support provided by the implant is maintained after its resorption by the fibrous tissue which replaces it. The two-year cure rate in 85 patients was 93 per cent.

Staged flexor tendon repair utilizing temporary silastic rod implants has proved to be an effective method for restoring the grip function of severely injuried hands. Since its inauguration by CARROLL and BASSETT in 1958 this method has been successfully practiced by numerous hand surgeons. In this review the patho-physiological principles of the development of the so-called "pseudo tendon sheath" are described. The various findings as far as the formation of the new tendon sheath is concerned, are presented. The theories about incorporation of the subsequent graft and its revascularization are described. Following a detailed description of the surgical procedure our own results with 272 silastic rod implants in 184 patients are presented. Because of the kind of patients selected for the procedure, excellent results were not obtained. However, in 62% of cases results were graded "good" and in 23%, "satisfactory", while 15% were "poor". It seems to be justified to utilize two-stage flexor tendon repair for restoring grip function in severely injured hands in spite of the considerably high technical requirements, the prolonged course of rehabilitation and consequently increased cost of treatment.

Since 1974, 93 men with erectile impotence have been treated with surgical implantation of an inflatable penile prosthesis. Followup has been 6 months to 4 years. Long-term functional success was achieved in 87 patients (93%). Complications requiring 31 secondary operations occurred in 27 patients (29%).

During a period of 8 years over 200 cases of carcinoma of the breast have had replacement procedures carried out as either a primary or a delayed procedure. The end results do not appear to be in any way inferior to those of conventional treatment of this condition. Selection of cases is important, but equally vital is meticulous dessection technique, haemostasis and planning of incisions together with preservation of the blood supply. Recurrence locally appears to be somewhat less than anticipated when compared with other methods of treatment. It can be treated by irradiation or excision without removal of the prosthesis.

Tracheal reconstruction with a new type of prosthesis made of heavy Marlex mesh and pericardium is described in 13 patients suffering from malignancy. Two patients had circumferential excision of the trachea, and the remaining 11 had partial circumferential excision and a patch graft. In 10 of them, tracheal excision was a part of block pulmonary resection. The early results are good enough to allow us to continue using the prosthesis in suitable cases.

A total of 112 cases of pyeloplasty were analyzed and the advantages of inner pyelovesical splinting as opposed to external drainage are outlined. Long-term results especially favor the former procedure. Scanning electron microscopic studies were done on the splinting material.

Among 640 patients operated upon due to multiple recurrences of ventral hernias Spigelian hernia was revealed in 11 cases, and primary surgery for Spigelian hernia was performed only in one case. The diagnosis of Spigelian hernias in this category of patients presents considerable difficulties. It is the authors' opinion that operative treatment of Spigelian hernias after repeat operations on abdominal organs should be performed with application of allomaterials. As an alloprosthesis the authors recommend to use a specially manufactured material from Lavsan threads No 200 with 2-3 mm mesh. An examination of patients 10-12 years following herniotomy indicated that neither recurrent hernia nor complications related with the utilization of Lavsan alloprosthesis were noted in any case.

We have found that small defects, particularly those within the hairline, are easily reconstructed with methy methacrylate prepared at the operating table. Larger defects, especially in children and active adults, are benefited by autogenous bone grafts and we prefer split rib. When the fabrication facilities are available the preformed silicone implants offer much to the surgeon. They may be sculptured to correct difficult contour problems such as in the supraorbital or forehead region and are especially useful to fill in defects where the bone is present, but depressed. These three methods have many advantages over the metallic implants. There is little complaint of the implant being cold when the patient is exposed to cold weather and a very important fact is that these methods not only provide a radiolucent reconstruction, but also do not affect EEG examination.

Initial results with the Plastipore TORP (Total Ossicular Replacement Prosthesis) show good results in large groups of ear in which all or most of the ossicles have been missing or not suitable for reimplanting. The reconstruction of the sound conducting mechanism of the middle ear is not difficult using the TORP prosthesis. Tissue readily grows into the large pores of the Plastipore, significant hearing gain can be achieved, and no rejection of the prosthesis has occurred thus far.

Based on our experimental results with the Bader tendon prosthesis, encouraging results for alloplastic tendon replacement were obtained. However a general recommendation for its clinical use cannot be given. Over a period of 4-6 weeks of immobilization healing of the artificial tendon with inflammation could be observed. In the biopsies we found the equivalent of connective tissue attachment between vital tissue and the alloplastic material. We could not clarify whether this connection would endure strain. The pronounced adhesions between the anstomosis and surrounding tissue make later function questionable.

The etiology of impotence and a review of various techniques in treatment are discussed. A perineal surgical approach with a new type of paired sponge-filled silicone prostheses is described. The prostheses are inserted into previously dilated corpora cavernosa. Of the initial 31 patients, excellent results were obtained 27, and a good result in 1. Of the 3 patients with initial serious complications, adequate functional results were attained in 2. The distinct advantages and potential complications using the Small-Carrion penile prosthesis and surgical technique are discussed.

Due to the improved prognosis of patients with primary malignant bone tumours, permanent attachment is also one of the problems encountered in the implantation of tumour endoprosthesis without bone cement, as surgeons are at present attempting to do in the case of conventional joint endoprostheses. The two methods which can be used for the cementless implantation of tumour endoprostheses are intramedullary stem fixation and extracortical attachment. Both methods require additional stabilisation by plates. Mechanical loading tests on 90 pairs of anatomical femurs showed that all the forms of attachment investigated exhibited adequate primary stability. However, it would appear necessary to fix two securing plates laterally and ventrally in order to achieve stable permanent attachment. The clinical results so far obtained with 18 cone endoprostheses and 12 stem endoprostheses are satisfactory. In the case of cone endoprostheses observed for an extended period after insertion, radiological checks showed the "incorporation" of the implant as an indication of stable permanent attachment. Radiological checks of patients with stem endoprostheses showed considerable structural movement in the area of the attachment. However, this did not result in signs of loosening so far. At the present time the cone attachment is preferable in view of the simpler operating technique involved and the more favourable radiological observations following the operation.

A polytetrafluoroethylene/vitreous carbon porous material has been investigated as an alternative to acrylic for hip endoprosthesis fixation. This material, which is mechanically fused to the endoprosthesis stem, has been shown to promote soft-tissue ingrowth. In 29 patients receiving a porous-coated Thompson endoprosthesis, stabilization of the porous-coated stem as observed by acceptable clinical results occurred in only about 50%. Stabilization of porous-coated endoprostheses is unsatisfactory for the following reasons: lack of press-fit, inadequate prosthetic design, infection, and technical difficulties. The major cause of 40% failure in this series was an initially inadequate press-fit.

During the last 3 years 16 patients have undergone insertion of the Rosen urinary incontinence device. The urethra is occluded simply by fluid transfer from a scrotal reservoir to a perineal balloon that is fixed to the inside of the bulbocavernosus muscle. Use of extensive tubing and hydraulics is not required. Experience with this prosthesis in the management of male urinary incontinence will be discussed. Its use in conjunction with the Small-Carrion penile prosthesis in selected patients with impotence will be described briefly.

The role of fiberendoscopy with regard to various dilatatory procedures is discussed. In particular detailed information is given for dilatation of tight asymmetrical fibrous strictures, with metal olives, for dilatation of advanced achalasia and for dilatation of obstructing gastro-esophageal malignancy, followed by positioning of a plastic prosthesis under endoscopic control.

The employment of the intraocular lens is an acceptable procedure in selected cases. It has great optical and practical advantages over conventional treatment. In the evaluation of suitable cases, clinical considerations, indications and contraindications are of major importance. The extraction of the opaque cataractous lens from the human eye is an eternally new, ever exciting operation which always has challenged the skill of the ophthalmic surgeon. It is not easy and it always involves a risk. The additional demands of technique incurrent in the insertion of the intraocular pupillary lens render the operation still more difficult and increase the risks. The results presented and the advantages achieved justify, in my opinion, the use of an intraocular lens in selected cases of cataract extraction.

The key points in our method of repair of cryptotia are (1) to cover the skin defect on the posterior aspect of the ear after it is dissected from the head, and (2) to repair the cartilaginous deformity. We describe the use of a temporal skin flap for the former. For the latter, we make parallel incisions on the back of the superior crus and transfer a small graft of conchal cartilage there. The conchal cartilage graft "splints" the repaired crus against cicatricial contracture.

Eight ears with complications due to chronic eustachian tube insufficiency had insertion of a silicone rubber tympano-frontal shunt tube between the mastoid antrum and the ipsilateral frontal sinus. A one-way valve designed to open at -10 mm H20 was placed on the tympanic end of the tube to minimize tube obstruction by ear secretions. Follow-up an average of 20 months post insertion showed six of the eight ears to have an aerated middle ear without fluid or tympanic membrane retraction or perforation.

Two-stage correction of tuberous breasts is illustrated and probably indicated to attain a more aesthetically pleasing result in this unusual deformity. Routine augmentation mammaplasty corrects the base defects of vertical and horizontal contraction treating an appropriately placed breast mound. However, ptosis of the nipple-areola complex becomes obvious, and correction with creation of a new skin brassiere is necessary. Merely telescoping the breast tissue into the nipple-areola complex has not always produced a satisfactory long-lasting result. Subsequently, a true ptosis procedure on that breast deformity after augmentation mammaplasty has yielded the most aesthetically pleasing long-term results.

The deceiving results obtained by the single implantation of mammary prostheses in the treatment of the small ptotic breasts are the consequence of faulty judgment and lack of recognition of the various anatomical elements involved in the deformity and which bear an incidence on the operative technique and the final esthetic result. By studying the three inseparable elements -ptosis, skin and hypoplasia -a classification into three types of small ptotic breasts is proposed, based mainly on the origin of the ptosis and the hypoplasia and on the static qualities of suspension and coverage of the skin : Type I : primary small ptotic breast. Type II : secondary small ptotic breast with normal skin. Type III : secondary small ptotic breast with skin of bad quality. The respective indications and prognosis of the classical methods of treatment are reviewed according to this classification. The single implantation of mammary prostheses has only restricted indications : when the ptosis of the nipple and/or the lower pole of the breast does not exceed 1 tot 1,5 cm. In all the cases where the ptosis is more pronounced, the single implantation is contraindicated and a reshaping operation will be performed. In cases where the reshaping operation does not give enough volume to the breast, a two-stage procedure is strongly recommended by the author : a reshaping operation, followed in a second stage by the implantation of the adequate prosthesis as soon as the local conditions are favorable.

Hearing results and causes of failure with three types of ossicular reconstruction techniques over an intact stapes, during second-stage intact canal wall tympanoplasty, are reported herein. The three types of reconstruction are: fitted autologous incus (38 cases); Plastipore PORP with cartilage (41 cases); Plastipore PORP without cartilage (32 cases). A residual air-bone gap within 15 dB. was found in 63.2 per cent of fitted includes, in 41.5 per cent of PORPs with cartilage, and in only 37 per cent of PORPs without cartilage. Eighty-four per cent fitted incudes, 63 per cent PORPs with cartilage and 44 per cent PORPs without cartilage yielded a residual air-bone gap within 25 dB. Extrusion has been the main cause of failure among Plastipore prostheses.