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Background: Ectropion repair is a challenge in plastic surgery. Depending on the etiology of the underlying problem, a variety of surgical techniques are available. The etiology, operative management, and recurrence rate are presented., Objective: An improvement of the deformity or, in the ideal case, a functional and aesthetic restoration should be accomplished., Materials and Methods: In this study, 58 patients with ectropion treated from June 2002 until March 2004 were analyzed, 33 with scar contractures, 13 with a tumor of the lid margin, 8 with facial paralysis, and 4 with senile ectropion. Surgical procedures included lateral or medial canthopexy, lateral tarsorrhaphy, wedge excision, skin graft, local flaps, cartilage graft, fascial slings, and combined procedures in one-third of the patients., Results: Postoperative complications included incomplete correction and others in 18.9% of the patients. Eight patients (13.8%) had to be reoperated., Conclusion: Correction of the lower lid area including restoration of the lid margin in terms of shape and position is the surgical end point. The preoperative analysis is mandatory for a surgical solution to this severe problem, which is associated with a high incidence of recurrence, especially in difficult reconstructive cases. An individual sophisticated strategy combined with experience in the variety of surgical techniques is mandatory. Frequently, multiple procedures are necessary.

The repair of bony defects in the craniomaxillo-facial region in 40 patients is reported. In 22 patients with autogenous calvarian bone grafts no changes in the grafted bone were found. However, in 4 out of 11 patients with iliac bone grafts, partial bone resorption was observed. Repair of bony defects of the face with autogenous calvarian bone is the therapy of choice. It is superior to any other transplant or implant.

The structure of the weight-bearing plantar skin and the subcutaneous cushion is adapted to mechanical loads of 3-10 kp/cm2 under walking conditions. Such loads, however, are only tolerated when compensated by constant alternation of loaded points. If the surgical therapy with free skin grafts or pedicled flaps does not take into account the vascular and neural architecture of the plantar skin, healing without problems may result--but only for a short time. As a rule, such grafting is later followed by painful keratotic lesions or non-healing "trophic" ulcers, which are caused by loss of sensitive innervation, changing of loaded points as well as the specific subcutaneous architecture. Therefore, reconstructive surgery of loaded plantar skin often requires innervated musculo-cutaneous flaps. Plantar warts or other benign lesions with possible regression are not indications for grafting at all.

Radioulcera of the trunk appear very often in combination with an osteonecrosis or osteomyelitis of the ribs or the sternum. The surgical procedures are very much restricted by the high radiation stress of tissue and the severe chronic infection. The treatment with the common flaps and skin grafts is very long lasting and disappointing because of the extremely difficult wound healing. The surgical therapy has been essentially improved by the myocutaneous flaps. In the last three years 52 patients with severe and big ulcera of the trunk were successfully treated with the myocutaneous flaps. This procedure proved to be very worthwhile.

A report rarely a case of superficial spreading melanoma of the conjunctiva bulbi in a 40-year-old woman. As this kind of tumor is very found at this site, the unusual localisation rendered the differential diagnosis more difficult and delayed the radical operative therapy. After orbitectomy the patient has been free of local metastatic deposits for two years. She is fully rehabilitated by a good epithetis. The course of diagnosis in our case illustrates the necessity of uniform application of the nomenclature of cutaneous forms of melanomas and naevi in ophthalmology.