Effect of Iron-Erythrocyte Metabolism-Related Indexes on Posttraumatic Growth in Patients on Maintenance Hemodialysis (MHD).

Purpose: To investigate the effect of iron-erythrocyte metabolism-related indexes on posttraumatic growth in MHD patients and their caregivers. Patients and Methods: A total of 170 pairs of MHD patients and their caregivers in Shanghai Changhai Hospital were enrolled in this research, which used sociodemographic characteristics, the Posttraumatic Growth Inventory (PTGI), the Perceived Social Support Scale (PSSS), and the Medical Coping Modes Questionnaire (MCMQ). The test data of 141 patients were retrieved from the hospital database. Results: Single-factor analysis showed that the PTGI score of patients with a mean corpuscular erythrocyte volume ≥ 100 fL was 85.4 ± 19.8 and those with a mean corpuscular erythrocyte volume lower than 100 fL were 70.6 ± 24.7; the PTGI scores of patients with reticulocytes >1.5% were 68.8 ± 25.8, and those with reticulocytes <1.5% were 78.4 ± 21.1; the PTGI scores of the caregivers whose serum iron was >10.6 µmol /L were 78.2 ± 21.6, and those with serum iron <10.6 µmol /L were 67.9 ± 22.8. The difference in MCMQ scores between the caregivers with transferrin saturation>50% and with transferrin saturation<20% was 18.9 ± 8.4. For the correlation test of serum iron, reticulocyte and PTGI scores for patients, the Pearson correlation coefficients were 0.239 and -0.193, respectively, and the correlation test between erythrocyte distribution width SD and the score of caregivers MCMQ scale, the Pearson correlation coefficient was 0.225; p for all was< 0.05, with significant differences. There was no significant difference in the scores of different scales for total iron binding capacity (TIBC) at different levels. Conclusion: The indexes related to iron erythrocyte metabolism in MHD patients are correlated with ruminant meditation of patients and their caregivers and promotion of posttraumatic growth. Good nutritional status, adequate hematopoietic material, and normal erythrocyte count and function are also important for them.

Lateral lip-splitting approach for total and subtotal maxillectomy.

PURPOSE: This study reviewed our patients who underwent maxillectomy by the lateral lip-splitting approach and evaluated postoperative outcomes. PATIENTS AND METHODS: Thirty-six patients with diseases in the maxilla, maxillary gingiva, and hard palate who underwent total or subtotal maxillectomy by the lateral lip-splitting approach. The marginal mandibular branch of facial nerves were dissected and preserved before and after the procedure to split the lateral lower lip in all patients. Seventeen patients were reconstructed with free vascularized flaps. Postoperative radiotherapy was administered in 26 patients. The patient's self-assessment and examiner's evaluation were included in the postoperative assessment. The patient's self-assessment included answering a questionnaire, that included evaluation of buccal scar, symmetry of cheilion, lower lip movement, oral incontinence, and lower lip sensation. The examiner's evaluation included assessment of the functions of the facial nerve. RESULTS: All tumors were removed en bloc with sufficient safety margins except 1 adenoid cystic carcinoma in maxilla. The average mouth opening was 3.81 cm. According to the results classified as good, fair, and poor by questionnaires, most of the 36 patients thought their results were good or fair. Most of the patients were high scores, according to the examiner's evaluation. The overall 5-year survival and local control rates for patients with malignant tumors were 76.7% and 85.8%, respectively. The local and regional recurrent and distant metastasis rate was 12.9%, 6.5%, and 19.4%, respectively. CONCLUSIONS: The lateral lip-splitting approach is an acceptable and optional approach for maxillectomy because of wide exposure, satisfied function, inconspicuous scar, and preservation of facial nerve.

[Axial split osteotomy of free fibular flap for mandibular angle reconstruction: a clinical study].

PURPOSE: To introduce an axial split osteotomy of free fibular flap for mandible angle reconstruction and discuss its indications and surgical technique. METHODS: 16 patients underwent axial split osteotomy of free fibular flap(12 males and 4 females, aged from 23 to 62). 11 patients with benign tumors (8 ameloblastomas and 3 odontogenic keratocyst), 3 patients with osteoradionecrosis, and 2 patients with secondary mandibular deformity were included. The length of free fibular flap ranged from 10-17 cm (mean 14.6 cm). The length of the vascular pedicel ranged from 5-11 cm (mean 8.2 cm). The fibular flap harvested was performed in routine manner. After elevating the periosteum and performing minimal dissection at osteotomy site only, axial splitting was performed using an oscillating saw. The first osteotomy was made on the external surface of the fibula, perpendicular to the main axis of the bone down to the level of the medullary canal. The second osteotomy was made along the main axis of the bone. The length of this osteotomy was between 2 and 3 cm. The last osteotomy was made perpendicular to the internal surface at one junction of the anterolateral and posteromedial surfaces down to the medullary canal, as was done for the first osteotomy. Then the harvested flap was contoured, which was achieved by raising the two bone segments and fitting them together. The angulation was 120 degrees. RESULTS: 16 flaps were monitored by Doppler ultrasound postoperatively and examined by colored ultrasound 3 months, 6 months after operation. The results revealed that the recipient sites healed primarily without complications. CONCLUSIONS: Axial split osteotomy is a reliable technique with maximum contact surface for bone union, and less bone loss, which can lengthen the transplanted bone to a certain extent. It is suitable especially for reconstruction of the defect of the angle of the mandible.