Dorsal reduction (humpectomy) is a simple maneuver in principle, yet it commonly results in irregularities and general inaccuracies, along with occasional internal valve compromise. Traditionally, spreader grafts have been applied to reconstruct an internal valve disrupted during dorsal reduction. Imbricating the dissected ends of the upper lateral cartilages at their interface with the septum (spreader flaps) allows the surgeon to use this tissue, which would otherwise be discarded, to reconstruct the internal valve and design an aesthetically pleasing nasal line. The application of a spreader flap is not only an easily reproducible technique to restore middle vault structure but allows for precise incremental control when performed at the time of humpectomy. To that end, the authors provide a detailed description of their internal valve reconstruction technique, which has been honed over the past 15 years.

The trapeziometacarpal joint is commonly affected by degenerative arthritis, presenting with pain, stiffness, and swelling at the base of the thumb. When conservative treatment fails, surgical intervention may be warranted based on clinical and radiologic staging as well as patient demand. The concept of replacing the trapeziometacarpal joint remains attractive because of the decreased pain and stiffness, prevention of thumb shortening, and earlier recovery of strength seen with implant arthroplasty. A technique of using a cementless PyroCarbon hemiarthroplasty implant that allows excellent range of motion and decreased postoperative stiffness and pain is presented, with a focus on dorsal capsular reconstruction to prevent subluxation of the implant.

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Background: Glomus tumors are uncommon vascular tumors of the hand. Malignant glomus tumors, now known as glomangiosarcomas, are exceedingly rare. Methods: A review of the diagnosis and treatment of malignant glomus tumors is presented along with a report of the largest malignant glomus tumor of the hand to date. Results: The review illustrates the diagnostic and management challenges of 6 previously reported glomangiosarcomas. Conclusion: The rare nature of malignant glomus tumors mandates case presentation and longitudinal analysis to help guide surgical management and optimize outcomes.