Rapid prototyped PGA/PLA scaffolds in the reconstruction of mandibular condyle bone defects.

BACKGROUND: Craniomaxillofacial bone defects are currently reconstructed by using computer-aided design and manufacturing (CAD/CAM) processes. We have developed a novel digital medical support system that enables us to custom-make scaffolds to repair craniomaxillofacial bone defects using three-dimensional computed tomographic (CT) images and a rapid-prototyping method. METHODS: We created positive molds using CT data, CAD/CAM and a rapid prototyping method using 3D printing. Custom-made poly (glycolic acid) (PGA) and polymers poly (lactic acid) (PLA) scaffolds were prefabricated by a positive-negative mold interchange technique. A laser scanning system was used to evaluate the accuracy of the PGA/PLA scaffold. Bone marrow stem cells were incubated with the scaffold to assess biocompatibility. RESULTS: The mean error was <0.3 mm and confidence was >or=95% when the error was <1 mm. Results from in vitro cell culture demonstrated that the PGA/PLA scaffold had excellent cellular compatibility. CONCLUSIONS: This pilot study suggests that custom-made PGA/PLA scaffolds infiltrated with bone marrow stem cells may be effective for future treatment of craniomaxillofacial bone injuries.

An integrated fat grafting technique for cosmetic facial contouring.

BACKGROUND: Although several methods of fat grafting have been reported, there is no agreement regarding which technique should be used for autologous fat grafting and the final outcome after fat grafting often depends on the technique used by a surgeon. In this report we present an integrated fat grafting technique developed over the years for cosmetic facial contouring. METHOD: Fat grafts were harvested under low pressure with syringes, processed with low speed centrifugation, and then injected into the affected areas of the face with low volume for each pass via multi-tunnels, multi-planes, and multi-points. We describe the above integrated fat grafting technique as '3Ls and 3Ms' technique. A total of 83 patients with temporal, cheek, and periocular hollowing, lean or aging face or facial asymmetry were injected with autologous fats between 1 and 3 times at interval of 3 to 6 months. All patients were evaluated clinically and followed up to 8 years. RESULTS: The absorption was found variable in different patients. Long-term follow-up proved that final correction after 1-3 injections of autologous fat had persisted for many years. Obviously improved facial contour was evident in most patients after autologous fat transplantations. More than 73.5% of the patients in this series were assessed as satisfactory by all 3 observers (patient, surgeon, and layerperson). Between 12.0% and 21.7% of the patients were mostly satisfactory. Less than 4.8% of the patients were unsatisfactory. CONCLUSIONS: Autologous fat grafting to the face is a safe and reliable option to improve facial contour in patients. The transplanted fat can survive well in the face with our integrated fat grafting technique. More than one injection may be required to achieve optimal outcome.

[Cervicothoracic prefabricated flaps for reconstruction of face and neck].

OBJECTIVE: To introduce a new prefabricated flap with matched colour, texture, thin enough thickness, large enough dimension and reliability for reconstruction of massive defect of face and neck. METHODS: The patients with massive scar of face and neck were selected for treatment with prefabricated flap. Flap prefabrication involved two stages. The "sandwich" structure including the descending branch of the lateral femoral circumflex vessels and surrounding muscle fascia was harvested from the thigh and anastomosed to superior thyroid artery or facial vessels. Flap prefabrication was performed by inserting the fascia flap between the cervicothoracic skin and the tissue expander placed beneath the skin. After a period of expansion, the flap was transferred to the recipient site based on the implanted vessels. The results including complications were examined during follow-up. RESULTS: Nine patients received this treatment. The average dimensions of fascia flap harvested was 6.3 cm x 11.2 cm. After mean interval of 16.7 weeks, the expanders were filled to a mean volume of 1670cc. The size of prefabricated flap ranged from 12 cm x 15 cm to 15 cm x 32 cm. In all cases, the flap efficiently covered the entire defect of the face and neck, and the donor site of the flap is closed primarily. All of the flaps developed venous congestion in some degree after the second operation. Partial flap necrosis occurred in two cases. Three flap was thinned to contour the bulky pedicle. During follow-up, the transferred flap was matched well to the adjacent skin. The reconstructed face restored nature contour and expression. Muscle weakness or paraesthesia was not found in the donor thigh. CONCLUSIONS: Cervicothoracic Prefabricated Flap, is reliable and versatile in the reconstruction of massive soft tissue deficits with restoration nature surface and expression of the face and neck.

In vitro and in vivo evaluation of a biodegradable chitosan-PLA composite peripheral nerve guide conduit material.

Chitosan, a nature biodegradable material, has good biocompatibility but poor physical properties to serve as a nerve conduit. In this study, polylactic acid (PLA) was added to chitosan to form a composite material with improved intensity and elasticity, to be used as nerve conduits. The chitosan-PLA nerve conduits were fabricated with a mold casting/infrared dehydration technique. The constituent ratio of PLA and chitosan of 1:5 (v:v) was chosen to give the composite material both good mechanical properties and good biocompatibility. An in vitro cytotoxicity test showed that the chitosan-PLA material was not cytotoxic. The conduits were proved biodegradable and had many micropores to allow permeability. We evaluated chitosan-PLA nerve conduits as a guidance channel to repair 10 mm gaps in rat sciatic nerves. Nerve autograft and silicon conduits were used as the control. After 12 weeks, the regenerating nerves in three groups succeeded in passing through the nerve gap and reinnervating the muscle. Assessments, including ECG, histomorphometric evaluation, and weighing of triceps calf muscle, showed that the functional recovery of sciatic nerve was better in chitosan-PLA conduit group than in the silicon conduit group (P < 0.05), but the differences between the chitosan-PLA conduit group and the nerve autograft group were not significant (P > 0.05). Therefore, the chitosan-PLA guide proved to be a promising nerve conduit.

[Three case reports of abdominal compartment syndrome after full abdominoplasty].

OBJECTIVE: To improve the safety of the abdominoplasty by the study of the complication of abdominal compartment syndrome after abdominoplasty. METHODS: Three cases were analyzed and discussed respectively in aspects of clinic symptoms, pathological reason, treatments and follow-up results. The treatment was the incision of musculoaponeurotic system, which usually cause defect of abdominal wall after pressure releasing. The defect of musculoaponeurotic system was reconstructed by Mesh, and the defect of skin was repaired by skin graft. RESULTS: The pathologic change of the complications was the shrinking of the belly cavity's volume and the increasing internal pressure of the abdomen caused the internal pressure of the thoracic cavity increase. The clinical manifestations included compressive feelings of chest and abdomen, high urinary frequency and psychiatric symptom. 2 patients accepted the operation. The abdominal compartment syndrome disappeared after the operation, and the results of the two years follow-up were satisfied. CONCLUSIONS: Full abdominoplasty has the risk of causing abdominal compartment syndrome. This complication can be cured by decompression of abdominal wall. The effect is stable after long time's follow-up. Special preventive methods should be used in high-risk patients to avoid this complication.

[Application of aesthetic sub-unit principle in nasal reconstruction and repairing of nasal defects].

OBJECTIVE: To evaluate the significance and effect of nasal aesthetic sub-unit principle. METHODS: Based on nasal aesthetic sub-unit, 27 patients were divided into 5 groups according to their nasal defects. They were nasal dorsum, tip, alar lobule, soft triangle and two or two above nasal subunit defects groups. Local restore were applied in defects which were less than 50 percent of one nasal subunit. Total nasal subunit reconstruction were applied, if areas of defects were larger than 50 percent of one nasal subunit 10 cases were received free tissue transplantation (including free skin transplantation, composite auricle transplantation, etc), 4 cases were received local flap, and 13 cases were received forehead flap. Following up for 5 to 37 months, evaluation item were contour and color. RESULTS: Skin transplantation and local flap were all survived. Auricle composite flap were all survived except for 2 cases whose epidermis looked red and purple. These two case's epidermis regained normal 6 months after operation. Forehead flap for nasal reconstruction were all survived, but one of them had to perform secondary surgery for coverage of the exposed nasal frame. 27 cases were followed up in all. Patients and their family members were satisfied with the nasal's contour and color. CONCLUSIONS: Good aesthetic effects comes from nasal aesthetic sub-unit principle in nasal reconstruction and repairing of nasal defects.

[Repair of nasal lining in nasal reconstruction].

OBJECTIVE: To present a variety of techniques for providing nasal lining and discuss the application of these methods to specific nasal defects. METHODS: Regard of the nasal defect's location, size, or depth of involvement, the approaches were used with turnover nasal skin or scar flaps (n=17), the buccal mucosal flap (n=1), the nasolabial flaps (n=5), prefabricated flaps (n=1) for lining. A formal nasal reconstruction was then carried out with use of rib cartilage grafts for support and a forehead flap for cover. RESULTS: Necrosis of forehead flaps and lining tissues did not occur. 24 Cases have been followed for a 6-34 months period. Except some turnover scar flaps obstructed the airway and needed aggressive secondary surgical thinning, the other lining flaps remained stable from adequate restoration of form and function. CONCLUSIONS: It is important to evaluate the exact sizes, volumes and layers missing of the nasal defects before rebuilding the lining defect. Choosing the adequate operation can provide good aesthetic and functional results. The prefabricated flap is good to be used to reconstruct nasal lining in complicated cases.

[Anatomic study of supratrochlear artery and its application in nasal reconstruction].

OBJECTIVE: To study the anatomy of the cutaneous branch (CB) of supratrochlear artery and its relevance to the design of frontal flap in nasal reconstruction. METHODS: 10 fresh cadavers were dissected to study the position and course of the CB of supratrochlear artery (supraorbital rim and facial midline as landmark). The communication between the CB and supraorbital artery was also studied. 5 cases of ultra-thin frontal flaps and 11 cases of bi-flap( cutaneous flap and muscular flap) were designed on anatomic basis. The survival rate of flap, the stability and aesthetic appearance of the reconstructed nose were followed up. RESULTS: The supratrochlear artery gave off constant CB (1.18 +/- 0.36) cm from upper orbital rim and (1.35 +/- 0.34) cm from the midline of face. The CB passed in a subcutaneous plane and communicated with the bilateral muscular branch, CB of the opposite side and bilateral supraorbital artery. The supratrochlear artery only had CB with no muscular branch in 3 cases. All the flaps survived completely except one with blister on the nose tip which healed spontaneously. The postoperative aesthetic appearance was very satisfactory. CONCLUSIONS: The supratrochlear artery has constant CB. The frontal ultra-thin flap pedicled with the CB can improve the therapeutic effect of nasal reconstruction.

[The surgical treatment of severely injured vagina].

OBJECTIVE: To investigate the surgical methods of treating severely injured vagina. METHODS: A retrospective study was carried out on the clinical materials and results of 7 patients suffered from severe vaginal injury. RESULTS: Different surgical approaches such as trans-suprapubic, transperineal or both approaches were applied according to the position of the atresia, meanwhile, different surgical methods such as skin graft, free flap transplantation, vaginal mucous flap advancement, direct anastomosis of the two ends, "Z" plasty was used to repair the vagina according to the different defect of the vagina, except for 1 case complicated with vaginorectus fistula, all the other cases were achieved satisfactory results. CONCLUSIONS: The accurate judgment of the severity of the vaginal injury and the understanding of the changed anatomy around the injured vagina was the key points to the success of the surgical treatment of traumatic vaginal atresia.

[Nasal reconstruction with forehead skin flap and muscle flap].

OBJECTIVE: To improve the paramedian forehead flap for nasal reconstruction. METHODS: Based on the findings of the Cutaneous branch of supratrochlear artery, the forehead musculo-cutaneous flap was divided into the musculo-flap and the skin-flap in 3 patients. The musculo-flap were used to reconstruct the septi-bone structure, and envelop silicon nasal-frame, while the skin-flap were used to reconstruct the nose. In 6 patients, the forehead flap was used as a skin-flap just with the muscle pedicle to reconstruct a nose with good appearance of nasal subunits, without the secondary operation. RESULTS: In all of 9 cases, the cutaneous-branch of supratrochlear artery was found 1.7-2.0 cm above the orbital-rim. Eight patients got good results, only 1 patient had to do the secondary operation to coverage the exposed nasal frame. CONCLUSIONS: The cutaneous-branch of supratrochlear artery could be an anatomical finding to form the forehead skin-flap and it is a good choice to be used to reconstruct a nose, even in complicated cases.

[Clinic applications of vascularized plantaris tendon grafting].

OBJECTIVE: To study a new method of the vascularized plantaris tendon transferring. METHODS: The vascularized plantaris tendon was elevated with the pedicle of the fascial perforating vessel or a small segment of the posterior tibial artery, which was transplanted to the wrist to repair the tendon defects of the flexor pollicis longus or the flexor digitorum muscle resulted from electric injury. According to the defects, the plantaris tendon can be used together with the skin, fascia, or both as a composite flap. 7 cases received the operation with complete survival of the flap. RESULTS: Postoperative follow-up showed satisfactory results in the 7 cases. Through physical exercises, the patients obtained increased joint motion and better function of the hand. CONCLUSION: The vascularized plantaris tendon has many advantages, including easy to harvest, easy to plerosis the donor site, little affect to a main vessel, able to repair the complex defects. This method has great potential for applications.