[Clinical application of titanium plate reconstruction of mandibular defect: 10 years of follow up].

OBJECTIVE: To summarize the postoperative complications of reconstruction of mandible defect with titanium reconstruction plate. METHODS: A total of 111 cases of the mandibular defect caused by various reasons and repaired by titanium reconstruction plate in the Department Oral and Maxillofacial Surgery of the affiliated Hospital of Qingdao University from 2003 to 2012 were collected and followed up. The complications were analyzed. RESULTS: Thirty-seven percent of 111 cases showed long term complications. The titanium fracture was the main complication(16%[18/111]), followed by stress-shielding (9%[10/111]), infection(8%[9/111]), and titanium plate exposure(4%[4/111]). Titanium plate fracture occurred within 8 months and 3 years after surgery. The simple titanium plate reconstruction had the highest rate of plate fracture(30%[15/50]). Stress-shielding in non-vascularized bone graft was more significant than that in vascularized bone graft(P<0.05). When replaced by mini-titanium plate, the stress-shielding effect disappeared gradually. When the retention of mandibular margin height was less than 1 cm with the use of reconstruction plate, the postoperative complications were prone to occur. CONCLUSIONS: Bone graft is the best way to reconstruct mandibular defect, and simple reconstruction plate repair is applied only as a transitional means for high degree of malignancy, obvious recurrence tendency tumor or special reasons such as age etc, which are not suitable for bone graft. The reconstruction plate fixation is not recommended for bone graft, especially non-vascularized bone graft. The retention of mandibular margin with reconstruction plate fixation is open to discussion.

The use of tissue expansion in lower extremity wounds in paraplegic patients.

A report of the use of tissue expansion in the lower extremity of paraplegic patients is presented with over 1-year follow-up in two cases. Expansion was accomplished without difficulty and without compromise of skin integrity when performed carefully and slowly. It is important to observe the overlying skin for capillary refill. Pain, which may limit expansion in neurologically intact patients, is not a factor in paraplegics. By using tissue expansion, more risky, longer procedures using myocutaneous flaps or microvascular tissue transfers may be unnecessary, and reliable, durable, full-thickness coverage is obtained in two short procedures.

A case of invoking a Scot's economy or seven-in-a-stroke.

The principle of invoking a Scot's economy or "never throw anything away" is useful for nearly every reconstructive procedure. A case of unilateral brow ptosis and temporal hollowness is presented here whereby the application of this principle allowed a single flap to perform multiple functions in the course of correcting the deformity.

A challenge to the undefeated nasolabial folds.

Previous attempts to improve the nasolabial folds have been disappointing. By extending the face lift skin dissection to the nasolabial fold and up onto the malar prominence, reducing the fat of this fold by excision, and applying direct posterior retraction to the freed facial skin, rather dramatic improvement in the nasolabial folds have been achieved. This is a preliminary report with a follow-up of 8 months or less.

Candida albicans tenosynovitis of the hand.

Invasive fungal infections of the hand are extremely rare and usually require an immunocompromised host. We report the first known case of Candida albicans tenosynovitis of the hand presenting as a mass in a boy with Buckley's immunodeficiency. Treatment was successful after radical synovectomy of both the flexor and extensor aspects of the hand after he failed to respond to combined amphotericin B and 5-fluorouracil therapy. Fungal tenosynovitis should be considered when swelling and decreased range of motion occur in the hands or digits of an immunocompromised host, especially if pain is not a prominent symptom.

Lateral antebrachial cutaneous nerve injury as a complication of phlebotomy.

The lateral antebrachial cutaneous nerve may be injured by attempts at cephalic vein venipuncture because of its anatomic location under the cephalic vein. Multiple attempts at venipuncture using plunging-type action should be avoided. Electric dysesthesias during venipuncture should alert the phlebotomist to possible nerve damage. Primary repair of the injured nerve or its fascicles may be hindered by tension across the antecubital fossa when the elbow is in extension or by the presence of the biceps tendon. As an alternative surgical solution, the neuroma may be resected and the proximal end buried within the substance of the brachialis muscle.