The free radial forearm flap has been one of the most common free flaps of recent decades. This flap is employed predominantly in head and neck reconstruction. The possibility of combining bone, muscle, and nerves with the fasciocutaneous flap greatly enhanced reconstructive options. However, the frequently unsightly donor site and the development of other readily available free flaps have led to a decline in the use of the radial forearm flap. Nevertheless, for reconstruction in head and neck surgery, with the need for thin, pliable tissues and a long vascular pedicle, the radial forearm flap still remains a prime choice. Two modifications of the standard forearm flap are presented. The first patient had two large defects at the nose and mental area after radical resection of a basal-cell carcinoma. Soft-tissue reconstruction was achieved with a conventional forearm flap and a second additional skin island based on a perforator vessel originating proximally from the pedicle. Both skin islands were independently mobile and could be sutured tension-free into the defects after tunneling through the cheek, with vascular anastomosis to the facial vessels. The second patient required additional volume to fill the orbital cavity after enucleation of the eye due to an ulcerating basal-cell carcinoma. In this case, the body of the flexor carpi radialis muscle was included in the skin flap to fill the defect. The skin island was used to reconstruct the major soft-tissue defect.

Arterial aneurysmata of the hand represent a rarity. Post-traumatic aneurysms of the ulnaric artery are subsumed under the so-called hypothenaric or hammer syndrome. This report describes a 36-year-old patient with a symptomatic aneurysm of the superficial palmaric arc distal to the ulnaric artery outside of the Loge de Guyon. The branches of the communicating digital arteries were part of the aneurysm. Unable to recall any trauma to the left hand, the patient had an impaired blood supply to the left second, fourth, and fifth fingers. He complained of unpleasant paleness, cold sensation, and pain there. Particularly remarkable was the absence of an anastomosis of the superficial and profound arterial arcs. The therapy was microsurgical resection of the aneurysm with end-to-end anastomosis of the superficial palmaric arc and reinsertion of the communicating digital arteries 4 and 5. After release of a haematoma, the wound healed without any complications and the complaints ceased. The suggested therapy concerning a cardiac infarction 5 years prior to the treatment was: 300 mg of aspirin for 12 months followed by 100 mg as a permanent medication.

Thibièrge-Weissenbach syndrome is a rare entity of generalized soft tissue calcinosis of the hand associated with scleroderma. Patients present with tumorous deformities of the hand and phalanges which are easily misdiagnosed as rheumatoid arthritis. The diagnosis is confirmed by conventional X-rays. Treatment options are limited to local excision of painful or ulcerated nodules. Multiple operations are frequently required due to the high incidence of local recurrence. Two clinical cases and a review of the etiopathogenesis of the Thibièrge-Weissenbach syndrome are presented.

Instead of a "physiological shape of the lumbar spine" its "physiological function" or its "physiological interaction between shape und function" should be in the focus of future discussions. In the sitting, hip joint flexion leads to a coupled motion of the thighs, the pelvic girdle and the lumbar vertebral column with the consequence of a kyphosation of the lumbar back shape.