ABSTRACT
Objective To report the clinical outcomes of latissimus dorsus flap used to reconstruct severe trauma on lower leg.Methods From May 2011 to September 2016,12 patients were treated for severe trauma on lower leg at Orthopaedic Department,General Hospital of Rocket Force.They were 10 men and 2 women,aged from 22 to 54 years (average,37.5 years).According to the Gustilo classification,their open fractures were of type ⅢA in 2 cases and of type ⅢB in 10.The areas of soft tissue defect ranged from 15 cm × 8 cm to 35 cm × 12 cm.Their wounds were covered with latissimus dorsus flaps;the dorsal expansion of the ankle joint was reconstructed after their bone infection was controlled.Two flaps were anastomosed directly to the anterior tibial vessels and one flap to the femoral vessels.The other 9 flaps were anatomosed to the lateral circumflex femoral artery,bridging with the greater saphenous vein (average length:32 cm).Ten flaps were neuroanatomosed with the motor branch of common peroneal nerve and 2 with the motor branch of vastus lateralis.The therapeutic outcomes were evaluated in terms of repair of soft tissue defects,control of infection and range of active dorsal flexion of the ankle at neutral position.Results The 12 patients were followed up for an average of 3.5 years (from 1 to 6 years).All the 12 flaps survived and infections were eradicated.The fractures were healed with muscle strength of grade 3 to grade 4.Their ankle extension was reconstructed.Their limbs were preserved with satisfactory limb function.The bone exposures of 5 cm × 3 cm and 6 cm × 3 cm in area after debridement respectively in 2 cases of Gustilo type ⅢA were covered with latissimus dorsus flaps.The range of active dorsal flexion of the ankle at neutral position increased from preoperative 10.5° to postoperative 19.1° on average.Conclusion In treatment of severe trauma on lower leg,latissimus dorsus flaps can be used to repair skin wound,control infection and reconstruct ankle function simultaneously,with advantages of reduced operative procedures,a high rate of limb preservation,and better function recovery.
ABSTRACT
This paper is aimed to develop a computerized three dimensional system for displaying and analyzing mandibular helical axis pathways. Mandibular movements were recorded using a six-degrees-of-freedom ultrasonic jaw movement recording device. The three-dimensional digital models of the midface and the mandible were reconstructed and segmented from CT skull images. The digital models were then transformed to the coordinate system of mandibular motion data by using an optical measuring system. The system was programmed on the base of the Visualization ToolKit and Open Scene Graphics Library. According to the motion data, transformation matrices were calculated to simulate mandibular movements. Meanwhile, mandibular helical axis pathways were calculated and displayed three dimensionally by means of an eigenvalues method. The following parameters of mandibular helical axis were calculated: the rotation around instantaneous helical axis, the translation along it, its spatial orientation, its position and distance relative to any special reference point. These parameters could be exported to describe comprehensively the whole mandiblular movements. It could be concluded that our system would contribute to the study of mandiblular helical axis pathways.
Subject(s)
Humans , Imaging, Three-Dimensional , Mandible , Models, Anatomic , Movement , RotationABSTRACT
Objective:To analyze occlusal contact areas on the working and nonworking sides during unilateral mastication.Methods: Eighteen subjects without any temporomandibular disorder(TMD) symptoms participated in the present study.The subjects were presented with 3 g gum for right masticating.Chewing movement was simulated using virtual craniofacial movement simulation system.Then occlusal contact areas were calculated at four selected moments during the closing phase in the third chewing cycle: the occurrence of occlusal contact,one third time,two thirds time,the intercuspal occlusion.Results: During the closing phase in the third chewing cycle,the total occlusal contact areas on working side increased from(9.3?0.4) mm2 to(39.2?1.2) mm2,and that on nonworking side increased from(2.3?0.5) mm2 to(40.3?1.2) mm2.At the occurrence of occlusal contacts,occlusal contact areas of the first and second mandibular molars were on average(3.7?0.2) mm2 and(3.5?0.2) mm2 on working side,and(0.5?0.2) mm2 and(1.2?0.3) mm2 on nonworking side,respectively.However,when the mandible moved to the intercuspal position,their areas were sharply increased to(14.8?0.7) mm2 and(13.9?0.4) mm2 on working side,and(13.6?0.5) mm2 and(12.1?0.5) mm2 on nonworking side,respectively.In addition,nonworking-side contacts were observed for 12 subjects at the occurrence of occlusal contacts,and for all subjects at two thirds time.Conclusion: This paper provides a new method useful for analyzing occlusal contacts during functional movements.This study revealed the pattern of occlusal contacts during the closing phase in the chewing cycle.Moreover,it was confirmed that nonworking-side contacts occurred during unilateral mastication.