Surgical Resection of Sternal Tumors and Reconstruction with Titanium Mesh

Objective To evaluate the use of titanium mesh reconstruction after sternal tumor resection. Methods From January 2007 to January 2011, 14 patients with sternal tumors were admitted into Peking Union Medical Hospital. The clinical characteristics, surgical resection, and technique of reconstruction were reviewed. Results Of the 14 patients, 3 had a metastatic sternal tumor, the primary sites of which were as follows: hepatic carcinoma in one case (metastasis 19 years after operation), breast carcinoma in another case (metastasis 5 years after operation), and renal carcinoma in the other case (found simultaneously). Two patients showed local involvement of the sternum: 1 had thymic carcinoma, and the other had myofibrosarcoma. The remaining 9 patients had primary tumors: 4 were osteochondroma, 3 chondrosarcoma, 1 eosinophilic granuloma, 1 non-Hodgekin's lymphoma. En bloc resection of the sternal tumor was performed in all the 14 patients. The defect was repaired with the titanium mesh adjusted to the shape of the defect and fixed with the stainless steel wire. Eleven patients were followed up for a period from 2 months to 4 years, during which no translocation or broken of the titanium mesh was observed. Conclusions Radical en bloc excision remains the treatment of choice for sternal tumors. Sternum defect reconstruction using titanium mesh as a rigid replacement proves appropriate and effective.

High Scalp Tension after Three-Dimensional Titanium Mesh Repair for Skull Defect: 2 Case Reports

Rationale: The three-dimensional (3D) computer-made titanium mesh is widely used in the skull repair for those patients receiving decompression of the bone flap. It can restore normal anatomy to a greater extent and make a better appearance. Case Presentation: We reported two cases of patients admitted to our hospital who have experienced high scalp tension after skull repair. At first, these two patients underwent decompression of the bone flap, and the physical examination results showed a defect of skull. No neurological symptoms and signs were found. The 3D computed tomography (CT) reconstruction of skull was performed, and then the skull repair with 3D titanium mesh was conducted. But because of high scalp tension, they underwent a second operation, during which we re-trimmed and reduce the arc of the titanium mesh. The scalp incision of both patients healed well and no titanium mesh was exposed. Both patients have a good prognosis. Lessons: We highlight that the high tension of scalp due to overstretching after 3D titanium mesh repair for skull defect should be paid much attention to. Trimming and reducing the arc of titanium mesh is an effective treatment for this situation.

Research Progress of Titanium Polypropylene Mesh in Breast Reconstruction

To investigate the application of titanium polypropylene mesh in breast reconstruction.In this study,we selected the literature data in recent 4 years to analyze the application of titanium polypropylene mesh in breast reconstruction.Using the keywords of"breast reconstruction,""titanium polypropylene mesh,^^"application"and"research progress,we analyzed and summarized the related research progress of titanium polypropylene mesh in breast reconstruction.The research was conducted using the analysis of titanium polypropylene mesh,titanium polypropylene mesh in breast reconstruction surgery advantages,adverse complications related to titanium polypropylene mesh in breast reconstruction surgery and preventive measures.By constantly improving these aspects in the research process,the current study has certain value,and may guide the research work of titanium mesh in breast reconstruction.

Repair of infectious scalp defects with titanium mesh exposure by scalp rotation flap

Objective To explore the application of scalp rotation flap in reconstruction of infectious scalp defect with titanium mesh exposure. Methods Twelve patients were treated in this group including 4 males and 8 female. S The defective size ranged from 2. 0 cm × 5. 0 cm to 0.

Customized bioceramic scaffolds and metal meshes for challenging large-size mandibular bone defect regeneration and repair

Large-size mandible graft has huge needs in clinic caused by infection,tumor,congenital deformity,bone trauma and so on.However,the reconstruction of large-size mandible defect is challenged due to its complex anatomical structure and large-range bone injury.The design and fabrication of porous implants with large segments and specific shapes matching the native mandible remain a considerable challenge.Herein,the 6%Mg-doped calcium silicate(CSi-Mg6)andβ-andα-tricalcium phosphate(β-TCP,α-TCP)bioceramics were fabricated by digital light processing as the porous scaffolds of over 50%in porosity,while the titanium mesh was fabricated by selective laser melting.The mechanical tests showed that the initial flexible/compressive resistance of CSi-Mg6 scaffolds was markedly higher than that ofβ-TCP andα-TCP scaffolds.Cell experiments showed that these materials all had good biocompatibility,while CSi-Mg6 significantly promoted cell proliferation.In the rabbit critically sized mandible bone defects(∼13 mm in length)filled with porous bioceramic scaffolds,the titanium meshes and titanium nails were acted as fixation and load bearing.The results showed that the defects were kept during the observation period in the blank(control)group;in contrast,the osteogenic capability was significantly enhanced in the CSi-Mg6 andα-TCP groups in comparison with theβ-TCP group,and these two groups not only had significantly increased new bone formation but also had thicker trabecular and smaller trabecular spacing.Besides,the CSi-Mg6 andα-TCP groups showed appreciable material biodegradation in the later stage(from 8 to 12 weeks)in comparison with theβ-TCP scaffolds while the CSi-Mg6 group showed much outstanding mechanical capacity in vivo in the early stage compared to theβ-TCP andα-TCP groups.Totally,these findings suggest that the combination of customized strength-strong bioactive CSi-Mg6 scaffolds together with titanium meshes is a promising way for repairing the large-size load-bearing mandible defects.

Anatomy-related risk factors in Harm's mesh subsidence in cervical reconstruction after one-level corpectomy

Objective:To clarify anatomy-related factors in the cervical spine with subsidence of titanium mesh cage (TMC) after one-level cervical corpectomy and fusion. The effect of the cervical posture, segmental curvature and endplate gradient on this postoperative phenomenon was evaluated. Methods: Between August 2003 and March 2006, a total of the 236 patients underwent one-level corpectomy and TMC fusion. Their radiological examinations were reviewed and clinical outcomes evaluated. Results: In the patients who were followed up for 12 months, TMC subsidence occurred in 54 (28.6%) cases. C6 corpectomy had a significant higher risk (26/60, 43.3%) for TMC subsidence, which was correlated with the variation of the gradient of the vertebral endplates against cervical levels. Although the clinical outcome was comparable with those in the literature, the patients may have subsidence-related problems such as neck-shoulder pain, neurological deterioration and instrumental failure. Conclusion: To decrease the incidence of subsidence, TMC design should be optimized to be in line with anatomic characteristics of the cervical spine.

Titanium mesh fusion device in the treatment of thoracolumbar burst fracture

Thoracolumbar burst fracture, a common condition in clinic, often leads to severe spinal instability and neurologic deficit. In most cases, the compression that caused by backward protrusion of the fracture fragments to the spinal cord, makes complete decompression difficult through a posterior approach. Here, we reviewed the clinical records of 22 patients with thoracolumbar burst fracture treated by anterior corpectomy, decompression of the spinal cord, and implantation of titanium mesh cage.

Titanium membrane layered between fluvastatin-loaded poly(lactic-co-glycolic)acid for guided bone regeneration

The aimof this study was to investigate titaniummembranes(TMs)layered between poly(lactic-co-glycolic acid)(PLGA)containing fluvastatin(FS)for use in guided bone regeneration.Membranes consisting of PLGA,FS-containing PLGA(PLGA–FS),TM layered between PLGA(TM–PLGA)and TM layered between FS-containing PLGA(TM–PLGA–FS)were prepared,and their mechanical and chemical properties were evaluated.The TM groups showed statistically significant differences,in terms of tensile strength and elastic modulus,when compared to the PLGA groups.The release of FS was demonstrated to be higher in the TM–PLGA–FS group than the PLGA–FS group after Day 14.The effect of membrane implantation on the calvaria of Wistar rats was measured using micro-computed tomography(micro-CT)and morphometrical analyses,as well as histological observations.At 4weeks,the TM–PLGA–FS and TM–PLGA groups were found to have lower bone mineral density but higher bone formation,when compared to the control and PLGA groups.At 8weeks,the use of TM–PLGA–FS membranes significantly enhanced bone formation in the calvaria model,compared to the other groups.These results suggest that a TM layered between PLGA containing FS potentially enhances bone formation,thus showing good potential as a GBR membrane.

Titanium mesh implants exposure after cranioplasty in two children: involvement of osteogenesis?

Background: Although technically regarded as a simple procedure, titanium mesh cranioplasty could lead to various surgical complications, including postoperative implant exposure. However, there is little data available on the occurrence and risk factors of this complication in the pediatric population. Cases presentation: Two pediatric male patients, one 12-year-old and one 7-year-old, had decompressive craniectomy after traumatic brain injuries and subsequent cranioplasty with titanium mesh. However, both patients had skin defects developed gradually at the scalp adjacent to the surgical incisions, 11 and 7 months after cranioplasty, respectively. Implants removal surgeries were then delivered and, during the operation, some bone debris were found just beneath the skin defects in both patients. Because microbiological culture results of the exudations were negative, in addition to the long interval between cranioplasty and developments of skin defects, surgical infections might not be major causes of the observed titanium implants exposures. On the other hand, local osteogenesis and impaired scalp blood supply might contribute to their occurrence. Conclusions: Efforts should be made to achieve complete clearance of bone debris and protect scalp blood supply during the initial decompressive craniectomy in order to minimize the risks of subsequent titanium mesh exposures.

EVALUATION OF A TUBULAR MESH AND A SPIRAL STENT WOVEN FROM TITANIUM NICKEL ALLOY FOR PROSTATIC OBSTRUCTION IN PATIENTS AT HIGH RISK FOR SURGERY REPORT OF 62 CASES

The use of two urethral stents woven from titanium nickel alloy (TiNi) in the form of a tubular mesh or a spiral stent (both made in China) is described. They were implanted in 62 patients,vith prostatic outflow obstruction. till patients were considered contraindicated for surgery. They were divided into a spiral stent group (group I) treated between March 1992 and May 1993, comprising 35 cases, and a tubular mesh group (group 2) treated between October 1993 and December 1994, comprising 31 cases, including four failures in group 1. Thirty-three out of the 35 patients in group 1 were treated successfully. Good results were achieved in eight cases (22.8%) and significant improvements occurred in 24 (68.5%), giving a total effective rate of 91.3%, with a follow-up of 11 to 27 months. Fourteen stents were removed within 6 months after the insertion and six more were removed within 12 months. The mean effective time of the stent in situ was 10.8 months. All 31 cases in the mesh group were treated successfully. Dramatically good effects were obtained in 28 cases (over 90%) and distinct improvements were achieved in two, giving a total effective rate of over 96.5%, with a follow-up of 6 to 14 months (mean 10.5 months). Cystoscopy was carried out in 12 patients after 6 months following the insertion. The major part of the meshes became covered by urothelium. Compared with the spiral, the mesh makes it possible to insert a prosthesis with a larger diameter and anti-pressure. The spiral, however, can be used as a temporary alternative for the relief of prostatic obstruction. A tubular mesh can work well for the relief of prostatic obstruction and remain in situ without causing major problems for at least I year.

A modified technique of bone grafting pedicled with femoral quadratus for alcohol-induced osteonecrosis of the femoral head

Background Quadratus femoris pedicled bone grafting has yielded satisfactory long-term clinical outcome for osteonecrosis of the femoral head （ONFH） in pre-collapse ONFH without extensive lesion. However, for pre-collapse ONFH with extensive necrotic area, it is still challenging to preserve the femoral head. The current study aimed to introduce a new technique of deliquesce strut with titanium mesh containing bone grafting pedicled with the femoral quadratus and to evaluate its short-term outcomes.Methods From January 2008 to December 2008, 10 ONFH patients （12 hips） underwent operations by a new technique of deliquesce strut with titanium mesh containing bone grafting pedicled with the femoral quadratus （group A）.According to the ARCO classification system, there were two hips in stage Ⅱ B and 10 hips in stage Ⅱ C. Also in the same period, 12 ONFH patients （16 hips） underwent operations by the conventional procedure of quadratus femoris pedicled bone grafting （group B）. There were 6 hips in stage Ⅱ B and 10 hips in stage Ⅱ C. All patients were males and suffered from alcohol induced ONFH. For the new technique, the necrotic area was evaluated, and a titanium mesh piece of the same size （range from 2.5 cm×2.8 cm to 2.8 cm×3.4 cm） was obtained and shaped to match the contour of the head. The cancellous bone was first placed underneath the subchondral bone and was densely impacted （about 1 to 2 mm thick）.Then the titanium mesh piece was inserted. The length of the decompressive trough was measured. A titanium cylinder mesh cage with a diameter of 1.6 cm of the same length was obtained, with a ＂U＂ shaped window in the wall being created to make room for the muscle pedicle. The muscle pedicle bone was inserted into the titanium mesh cage to form a bone graft-titanium cage complex and, then the complex was inserted. The hundred percent score method was used for outcome evaluation. Clinical and radiographic outcomes were compared between group A and group B.Results The average operative time was 150 minutes （130 to 185 minutes） in group A, with an average of 130 minutes （120 to 180 minutes） in group B. The mean blood loss was 400 ml （300 to 500 ml） in group Aand 350 ml （250 to 500 ml）in group B. Group A patients were followed up for an average of 19.2 months （14 to 24 months）, with an average of 18.5 months （12 to 24 months） for Group B. Full weight bearing was allowed 5 to 7 months postoperatively. Pain and function were obviously improved. For group A, pain score improved from a mean of 9.8 points preoperatively to an average of 24.6 points postoperatively, and function score improved from a mean of 9.0 points preoperatively to an average of 17.4 points postoperatively. In group B, pain score improved from a mean of 9.5 points preoperatively to an average of 24.2 points postoperatively and function score improved from a mean of 9.2 points preoperatively to an average of 17.2 points postoperatively. The range of motion changed the least, with score improvement from a preoperative mean of 13.9 points to postoperative 16.8 points for group A and from a preoperative mean of 13.7 points to postoperative 16.5 points for group B. Radiographic score improved from preoperative 31 points to postoperative 38 points for group A, in comparison with an improvement from preoperative 31 points to postoperative 37 points for group B. At the latest follow up, 11 hips were rated as excellent and 1 hip was better for group A, with 14 hips being rated as excellent and 2 hips being better in group B. There was no statistically significant difference between groups A and B in clinical and radiographic outcomes.Conclusion For ONFH in stage ARCO llC, satisfactory clinical outcome can be achieved by the new technique in the short-term period while the long-term clinical outcome has yet to be determined.

Anterior cervical surgery methods for central cord syndrome without radiographic spinal fracture-dislocation

This study was aimed to explore the anterior cervical surgery methods to treat central cord syndrome without radiographic spinal fracture-dislocation(CCSWORFD),retrospectively analyze the cases of CCSWORFD,and evaluate the curative effect of anterior cervical surgery methods for CCSWORFD.Twenty four cases of CCSWORFD(19 males and 5 females),all suffering from cervical hyperextension injury,between 45–68(average 59)years old,were operated on by anterior cervical surgery methods.Among these,18 cases had been followed up for 6–24(average 15)months;18 cases,who had anterior decompression and platefixation with titanium mesh bone grafting or iliac bone grafting achieved reliable effects based on the Japanese Orthopedics Association(JOA)evaluation(improved scores of cases with titanium mesh bone grafting,t=2.800,P<0.05;improved scores of cases with iliac bone grafting,t=3.270,P<0.05)and reliable reconstruction of cervical spine.The two groups obtained the same curative effect(t=0.470,P>0.05).Most of these cases had degeneration of cervical vertebra.The decompression which relieves the oppression to the spinal cord can help lessen edema of the spinal cord,and earlyfixation for stability of cervical vertebra is better for the recovery of spinal cord injury.Anterior operation with titanium mesh bone grafting or iliac bone grafting are both reliable curative methods for CCSWORFD,and titanium mesh bone grafting can avoid the trauma of the supplying graft.Mesh bone grafting can also shorten hospital stay.