Clinicopathologic Characteristics and Prognosis Analysis of Marjolin's Ulcer in 40 Cases.

Marjolin's ulcer (MU) is a rare but aggressive epidermoid carcinoma observed in scars or wounds. This article provides comprehensive characteristics and prognostic details of MU. Clinical data of 40 patients with MU between January 2010 and December 2017 were analyzed retrospectively. Squamous cell carcinoma was the most common pathological type (35/40, 87.5%). Extended resection was performed to treat all cases with skin grafting or flap grafting. Follow-up duration ranged from 6 to 96 months (median, 52 months) and recurrence was noted in 9 cases. The 1-, 3- and 5-year recurrence-free survival (RFS) rates were 87.2%, 87.2%, 83.2% respectively and the recurrence rate was 22.5%. Univariate analysis revealed that cause of scars (P=0.044), lesion appearance (P=0.036), ultraviolet radiation exposure (P=0.000), depth (P=0.001) and histological grade (P=0.027) had a statistically significant correlation with prognosis of MU. Multivariate analysis revealed that depth (P=0.034, RR=2.681, 95%CI: 1.077-6.674) and histological grade (P=0.008, RR=2.820, 95%CI: 1.315-6.050) were independent prognostic factors for RFS. In conclusion, superficial infiltration and high-grade differentiation predict more favorable prognosis. Careful follow-up of high-risk groups is strongly recommended to prevent recurrence and improve prognosis.

Expanded Paramedian Forehead Flaps for Nasal Defects: Beyond Aesthetic Subunits.

BACKGROUND: Reconstruction of nasal tip defects presents a significant challenge for plastic surgeons. The form, function, and aesthetic appeal of all nasal subunits must be addressed. The expanded paramedian forehead flap is a good choice for nasal reconstruction, providing similar texture, structure, and skin color, and high reliability. This article discusses the authors' modification of the expanded paramedian forehead flap in reconstructing defects on or around the nasal tip. METHODS: Twenty-two patients with nasal defects located on or around the nasal tip were treated in our institution. Sixteen patients underwent nasal reconstruction with expanded forehead flaps. The other 6 cases with cartilage defect underwent reconstruction with expanded forehead flaps and autogenous rib cartilage grafts. Functional and cosmetic results were assessed by surgeon, patient, and patient's relatives using a scale from 1 to 10. RESULTS: The aesthetic appearance of all patients was significantly improved after surgery. Two cases had mild hyperpigmentation. Two patients considered the flaps too thick. Three cases had minor brow elevation at the donor site. There were no obvious scars at the donor sites. There were no serious complications, such as infection, flap necrosis, deviation, or collapse. CONCLUSIONS: The expanded paramedian forehead flap is a safe and effective method for reconstructing defects located on or around the nasal tip. Moreover, this technique can result in good functional and cosmetic outcomes with very few complications.

Clinical Outcomes of Digital Three-Dimensional Hydroxyapatite in Repairing Calvarial Defects.

PURPOSE: The objective of this article is to present the long-term outcomes of digital three-dimensional (3D) hydroxyapatite (HA) implants used for calvarial defects. Porous HA provide good results and have many characteristics, making it suitable for calvarial defect reconstruction. However, using HA may be associated with potentially serious complications, including infection and exposure. The authors used digital 3D HA for cranioplasty for many years and accumulated considerable experience from using it. The authors found that digital 3D HA is an effective method for cranioplasty, showing low complication rate. METHODS: A total of 57 patients underwent calvarial defect reconstruction with 3D HA from June 2009 to August 2016. The follow-up period was 1 to 5 years. RESULTS: Most patients (91.2%) were greatly satisfied with the esthetic outcomes of the surgery. The highest rate of complication was seroma (8.8%). Two patients developed postoperative infections (3.5%). One patient with infections was successfully treated with antibiotic therapy. Another patient was required to undergo an extensive surgical debridement followed by delayed autogenous bone reconstruction. One patient suffered from implant exposure. No hematoma, unexpected fractures, asymmetry, and contour or implant abnormalities occurred. CONCLUSIONS: The digital 3D HA implant was highly biocompatible and durable for the reconstruction of calvarial defects. With appropriate treatment, the proposed method was able to achieve a functional and cosmetic reconstruction with lesser complications.

Application of computer techniques in repair of oblique facial clefts with outer-table calvarial bone grafts.

OBJECTIVE: This study focused on the application of computer-aided and rapid prototyping techniques in the repair of oblique facial clefts with outer-table calvarial bone. METHODS: Five patients with oblique facial clefts underwent repair with outer-table calvarial bone. A mirror technique and rapid prototyping techniques were applied to design and prefabricate the individualized template for the preoperative repair of orbital inferior wall and maxillary anterior wall defects. Using computer software, the ideal region from which to take outer-table calvarial bone was located according to the size and surface curvature of the individualized template. During the operation, outer-table calvarial bone was fixed according to the shape of the individualized template, and bone onlay grafting was carried out after appropriate trimming. Surgical accuracy was evaluated by comparing the preoperative and postoperative 3-dimensional reconstructed images. RESULTS: With computer-aided and rapid prototyping techniques, all 5 patients had an ideal clinical outcome with few complications. The 3-dimensional preoperative design images and postoperative images fit well. Six-month to 8-year postoperative follow-up demonstrated that 4 patients had good aesthetic facial appearances and 1 had developed recurrence of lower eyelid shortage. CONCLUSIONS: Computer-aided and rapid prototyping techniques can offer surgeons the ability to accurately design individualized templates for craniofacial deformity and perform a simulated operation for greatly improved surgical accuracy. These techniques are useful treatment modalities in the surgical management of oblique facial clefts.

Rotating distraction osteogenesis to enlarge the skull space.

BACKGROUND: Distraction osteogenesis has been used to treat diminished skull space caused by craniosynostosis. Our report investigated the relationship between space volume change by computer technology and the intracranial pressure change. Cerebrospinal fluid (CSF) regular test and CSF biochemistry test were also performed to ensure the safety of distraction process. METHODS: Seven minipigs, weighing 15 to 20 kilograms, were chosen; 4 × 3 cm bone flap was lifted in the left parietal bone. The dura was carefully protected. The distractor and assisted apparatus were implanted. Distraction was started with 10-day latency, 1 mm/d distraction rates for 10 days. Twelve weeks after distraction, the distraction device and the assist apparatus were removed. All pigs underwent 3-dimensional computerized scans of the craniofacial skeleton, CSF pressure measurement, CSF regular test, and CSF biochemistry test before operation, after 7 days' operation, immediately after distraction was finished, 4 weeks after distraction, 8 weeks after distraction, and 12 weeks after distraction. The 3-dimensional datum was collected, and volume change of skull was measured by 3-dimensional medicine surface rendering software. RESULTS: All pigs tolerated the procedure. The mean volume 12 weeks after distraction was 87.93 ± 3.11 cm, which was also significantly higher than 79.46 ± 3.15 cm that of before operation (P < 0.001). The CSF pressure becomes maxim after 7 days' operation. The CSF pressure went down immediately after distraction was finished. Then, the CSF pressure kept stable but lower than the CSF pressure before the operation except 1 pig whose CSF pressure after operation was higher than the CSF pressure before the operation. Cerebrospinal fluid regular test and CSF biochemistry test show stable results, and the WBC does not rise during the whole process. CONCLUSIONS: The distraction osteogenesis is an efficient and safe method to enlarge the intracranial volume. The assisted apparatus of distraction is useful for rotating distraction. Three-dimensional DICOM datum and 3-dimensional medicine surface rendering are efficient for measurement of skull volume.

Porous polyethylene combined with split calvarial bone graft to cover complex calvarial defect.

BACKGROUND: Various kinds of grafts, such as autogenous bone grafts and alloplastic materials, can be used for the reconstruction of calvarial defects. The selection of the optimum material for the repair of cranial defects is the greatest problem in the reconstruction of calvarial defects. For some complex calvarial defects, simple use of autogenous bone grafts or alloplastic materials makes functional and cosmetic reconstruction difficult to achieve. Therefore, the current study uses a new method to repair complex calvarial defects. METHODS: Eight patients with complex calvarial defects underwent cranioplasty with porous polyethylene combined with split calvarial bone graft. Follow-up visits were conducted for 6 to 72 months to monitor the patients. RESULTS: Significant improvements in the contour of the skulls as well as in the aesthetic appearance of all the patients were observed. Moreover, no serious complications, such as infections, exposure, removal of the implants, and contour or implant abnormalities, were observed. Three cases displayed a transient extradural seroma collection, which was resolved through drainage and compression bandaging. CONCLUSIONS: The results of this pilot study indicate that the combined use of porous polyethylene and split calvarial bone graft may be useful for cranial reconstruction in patients with complex cranial defects.

Clinical outcome of cranioplasty with high-density porous polyethylene.

BACKGROUND: High-density porous polyethylene (Medpor) has long been used in cranioplasty and is still one of the best materials for calvarial reconstruction. Calvarial defects can be effectively reconstructed with fewer complications by using Medpor. This article reports our study on the use of Medpor in reconstructing calvarial defects. METHODS: Twenty-three patients who underwent cranioplasty from 1999 to 2011 were included in this study. In all patients, Medpor was used for calvarial defect reconstruction, and all were followed up for at least 6 months. RESULTS: Most patients were satisfied with the reconstructive outcome. Only 1 patient had an infection and 1 had transient extradural seroma. All complications occurred within 2 years, and no new complications were found during the long-term follow-up. CONCLUSIONS: Using Medpor in cranioplasty is an effective method for reconstructing calvarial defects.

Congenital skull defect and neurofibroma: without scalp and other abnormalities.

Congenital skull defect is a rare malformation that is usually associated with congenital anomalies of the scalp and comparable lesions in the brain, spinal cord, limbs, and skeletal muscle. Most previously reported cases have described skull defects with aplasia cutis congenita and other congenital abnormalities. Very few patients with skull defects present with an intact scalp or neurofibroma. The authors report an adult patient with a rare congenital skull defect and local neurofibroma.

[3-Dimensional reconstruction of MRI in patients with polyacrylamide hydrogel injection for augmentation mammoplasty].

OBJECTIVE: To investigate the effective diagnostic method for the patients with polyacrylamide hydrogen injection for augmentation mammaplasty. METHODS: MRI scanning (layer thickness 1mm, t2 _ ps3d_ cor alignment) was performed on 23 patients with polyacrylamide hydrogen injection for augmentation mammaplasty. The data were imported into computer and processed. 3D reconstruction and analysis modules were run subsequently to do the volume reconstruction and surface reconstruction to obtain stereoscopic images of the gel and adjacent structures in virtual reality, and to calculate the volume of the hydrogel. RESULTS: Among the 23 patients (46 breasts), the injected hydrogel with integrity capsule existed in retromammary space with no malposition in 5 cases (10 breasts). The capsule was not integrally formed and hydrogel was separately distributed with irregular edge in 6 patients (12 breasts). The pectoris major space, subcutaneous and gland invasion was found in 11 patients (22 breasts). Small amount of hydrogel sparsely distributed in mammary gland and degenerative muscular tissue in 1 patient (2 breasts) who had received extracting surgery before. The volume of hydrogel ranged from 220.309 ml to 372.371 ml (mean: 306.328 ml) in 22 untreated patients (44 breasts). CONCLUSIONS: The volume and distribution of hydrogel can be known clearly by 3D MRI reconstruction technique. This feasible technique is helpful in removing the hydrogel completely.