Objective:To study the clinical value of artificial dermis combined with autologous thin skin graft in the repair of burn scar contracture in joints.Methods:A total of 52 patients with burn scar contractures were enrolled in the No.5 Hospital of Baoding from July 2015 to April 2018. According to different methods of repair, 26 cases were used in each group. The observation group was treated with artificial dermis combined with autologous thin skin graft. The control group was treated with medium-thickness skin grafting. The survival rate of autologous skin was compared between the two groups. The tissue of artificial dermal polyester fiber was taken and HE staining was performed to observe the pathological changes. The Vancouver skin scar assessment score (VSS), functional activity, infection rate, wound healing time, and VSS score after healing of the donor site were compared between the two groups.Results:The survival rate of autologous skin in the observation group (92.31%) was not significantly different from that in the control group (84.62%) ( P>0.05). Compared with preoperative, the VSS scores at 3, 6 months and 1 year after operation in both groups were decreased ( P<0.05). The VSS scores of the observation group were lower than those of the control group at 3, 6 months and 1 year ( P<0.05). The excellent rate of functional activity in the observation group (100.00%) was higher than that of the control group (76.92%) ( P<0.05); There was no significant difference in the infection rate (3.85% vs 7.69%) and healing time of skin grafting area between the two groups ( P>0.05). The healing time of donor site was shorter than that of the control group ( P<0.05). The VSS score of the donor site was lower than that of the control group ( P<0.05). Conclusions:Artificial dermis combined with autologous thin skin graft can be used in patients with burn scar contracture in joints, which can improve the scarring of skin grafting area and donor site, shorten the healing time of donor site and improve the function of burn scar contracture joint.

Objective:To explore the effect of artificial dermis combined with autogenous thin skin graft on the survival rate of compound skin graft and the scar state of joints in burn patients.Methods:94 burned patients treated in Baoding Fifth Hospital from August 2017 to August 2019 were prospectively selected as the research objects. They were randomly divided into two groups with 47 cases in each group. The control group was treated with simple medium thick skin transplantation, and the observation group was treated with artificial dermis combined with autologous thin skin grafting. The recovery of the two groups (healing time of skin donor area, healing time of skin graft area, healing time under scab of burn area and hospitalization time) were compared. The survival rate of composite skin transplantation, wound healing, Vancouver Scar Scale (VSS) score, joint range of motion (shoulder abduction, knee flexion, knee extension), Burn Specific Health Scale-Brief (BSHS-B), Profile of Mood States-Short Form (POMS-SF) score and complications were compared.Results:The healing time of donor area, skin graft area, subeschar healing time and hospital stay in the observation group were shorter than those in the control group ( P<0.05). The wound healing in the observation group was better than that in the control group, and the survival rate of composite skin transplantation was higher than that in the control group ( P<0.05). After treatment, the scar state of the joint in the two groups was improved compared with that before treatment ( P<0.05); The scar thickness, vascular distribution score and total score of VSS in the observation group were lower than those in the control group ( P<0.05). After treatment, the joint range of motion in the two groups was improved compared with that before treatment ( P<0.05); The shoulder abduction, knee flexion and knee extension in the observation group were higher than those in the control group ( P<0.05). After treatment, the quality of life and psychological status of the two groups were improved compared with those before treatment ( P<0.05); The BSHS-B score of the observation group was higher than that of the control group, and the POMS-SF score was lower than that of the control group ( P<0.05); The incidence of complications in the observation group (4.26%) was lower than that in the control group (21.28%) ( P<0.05). Conclusions:Artificial dermis combined with autologous thin skin graft can significantly improve the survival rate of compound skin graft in burned patients, and can further reduce the scar condition of the joints of patients, reduce the incidence of complications, and effectively improve the prognosis of patients.

Oral and maxillofacial space infections (OMSI) are common diseases of the facial region involving fascial spaces. Recently, OMSI shows trends of multi drug-resistance, severe symptoms, and increased mortality. OMSI treatment principles need to be updated to improve the cure rate. Based on the clinical experiences of Chinese experts and with the incorporation of international counterparts′ expertise, the principles of preoperative checklist, interpretation of examination results, empirical medication principles, surgical treatment principles, postoperative drainage principles, prevention strategies of wisdom teeth pericoronitis-related OMSI, blood glucose management, physiotherapy principles, Ludwig′s angina treatment and perioperative care were systematically summarized and an expert consensus on the diagnosis and treatment of OMSI was reached. The consensus aims to provide criteria for the diagnosis and treatment of OMSI in China so as to improve the level of OMSI treatment.

Objective:To establish an animal model of bone distraction in the irradiated dog mandible.Methods:1 0 Chinese dogs were used.8 dogs received a unilateral irradiation of 60 Co(Group R)in the mandible with a total dose of 22.8 Gy in four 5.7 Gy frac-tions (biologically equivalent to 50 Gy/25 fractions).The other 2 dogs without irradiation served as the controls(Group C).Bilateral corticotomy was made 3 months after completion of irradiation.After a 1 -week latency period,bone distraction was activated at a rate of 0.5 mm twice daily for 1 0 days,followed by a consolidation phase of 8 weeks.New bone was evaluated by radiographic,histological and single photon emission computed tomography(SPECT)analysis.Results:One dog was excluded from the study due to anaesthetic death in group R.After 8 weeks of consolidation,no difference was found between the percent area of new bone of both groups.New bone was more mature and organized in Group C than that in Group R.SPECT analyses showed that there was active osteogenic activity in Group R.Conclusion:Distraction osteogenesis can be achieved in the irradiated dog mandible.

OBJECTIVETo investigate the accurate and individual treatment of temporomandibular joint(TMJ) injury based on 3D digital technology.

METHODSMaxillo-mandibular model was made using rapid prototyping technology based on the pre-operation 3D CT results. According to the 3D digital measurement results, TMJ concepts were ordered and the prosthesis was used to simulate the replacement surgery on the model. Then the joint replacement surgery was performed afterward.

RESULTS(1)After total replacement of TMJ, no pain happened and mouth open was not limited. Three months later, the joint position was normal and stable. The month open width was 4 cm. (2)After condyle replacement, primary healing was achieved with complete survival of bone graft. No edema was seen. Symmetric facial appearance was satisfactory.

CONCLUSIONSBilateral individual prosthesis for total TMJ or condyle replacement is an ideal method for TMJ injury.

Arthroplasty, Replacement ; methods ; Bone Transplantation ; Computer-Aided Design ; Humans ; Imaging, Three-Dimensional ; methods ; Joint Prosthesis ; Mandible ; Prosthesis Design ; methods ; Range of Motion, Articular ; Temporomandibular Joint ; anatomy & histology ; injuries

BACKGROUND:Rapid prototyping technique has been recently applied in the medical reconstruction and al ows the production of individual implant for patients with tissue defects, achieving an accurate repair.
OBJECTIVE:To repair discontinuous mandibular defects in dogs using rapid prototyped titanium plate in combination with autologous cancellous bone graft.
METHODS:Nine hybrid canines were used, and the skul was scanned using spiral CT. Then CT data were used to construct three-dimensional digital model, in which virtual partial mandibulectomy was performed, and an individualized bone-grafting plate was designed. A titanium plate was manufactured using rapid prototyping and titanium casting. Animal experiment was then performed. A 40-mm discontinuous defect in the right mandibular body was created in the involved dogs. The defect was restored immediately using the customized plate in combination with autologous cancellous iliac blocks. Sequential radionuclide bone imaging, biomechanical testing, three-dimensional microcomputed tomographic scanning, radiology and histological examination were used to evaluate the turnover of the grafts.
RESULTS AND CONCLUSION:A symmetric mandible was reconstructed using the rapid prototyped grafting plate. The grafted bone survived and got corticalized, while a fibrous intermedium was found between the bone graft and the plate. In the reconstruction of mandibular defects, optimal functional and aesthetic outcomes could be achieved using the rapid prototyped grafting plates.

BACKGROUND: There are many methods for repairing the hemifacial atrophy, the most common is preparing plaster facial mold of the patient, with wax piled on the surface to restore the patient's facial shape, and wax pattern serves as a reference of surgical pad. However, the therapeutic effect for the correction and treatment is not satisfactory due to varied abnormality and difficult plans.OBJECTIVE: To discuss the feasibility of manufacturing underlay for the treatment of hemifacial atrophy using computer-assisted design and rapid prototyping technology. METHODS: Skull of the hemifacial atrophy patient was scanned with Picker 6000 SCT, and the data obtained were processed in Voxel Q image workstation for 3-D reconstruction with volume rendering technique. After the interval lamination, the images were downloaded at 0.4-mm interval in a BMP format using CuteFTP 4.0 software. Then the transaxial 2-D image data were converted into digitized 2-D contour data by using image processing software developed by experimental team through a series of processes, including filtering, screening, noise reduction, and distortion correction. The edges and contour of the images was extracted to obtain a vector diagram of facial cranial cortical bone contour line. The digitized data were inputted into image processing software of Surfacer 9.0 for vector superposing, thus the 3-D wire frame and solid images of skull could be reconstructed. According to mirror-image symmetry relation, the point-cloud data of facial bone on the normal side was duplicated to the atrophied side. Thus a 3-D model of the underlay was produced between the atrophied bone and the mirror image of normal side. In order to compensate the atrophy of soft tissues, the model was designed 1.5 mm thicker. After the three-dimensional Surfacer data on the CAD were re-stratified, the contour editing of the underlay and the supporting set of prototype were completed in RpDataRepare, forming RP files and creating underlay template through rapidly output of the processing file for rapid prototyping required, as a reference of surgical procedures.RESULTS AND CONCLUSION: The 3-D solid model of the patient skull bone surface contour was obtained and simulacrum of the underlay was prepared with computer assistance and rapid prototyping. According to the simulacrum, the operation was carried out and got a satisfactory result. The manufacture of underlay for the treatment of hemifacial atrophy could be accomplished by computer assisted design and rapid prototyping in a highly precise and rapid manner. It is a promising technique in the field of individualized underlay making in craniofacial surgery.

BACKGROUND: A three-dimensional spiral computer tomography can display stereoscopic pictures with multi angles on films or computer screens. However, it is hard to display complex three-dimensional anatomical morphology on two-dimensional films or computer screens. Thus, three-dimensional models are needed in craniomaxillofacial surgery simulation or conceptual design.OBJECTIVE: To establish a three-dimensional skull model using spiral computer tomography data and to explore its application in craniofacial surgery.METHODS: Skull of the patient was scanned with Picker 6000 spiral computer tomography with 2.0 slice thickness and 1.0 pitch,and the obtained data were treated in Voxel Q image workstation for three-dimensional reconstruction with volume rendering technique. After having been downloaded to personal computer at 0.1 mm interval, the transaxial two-dimensional image data were converted into two-dimensional digitized contour data by using image processing software developed by the experimental team. The wire frame and solid images of craniofacial triangular facets could be reconstructed when the digitized data were inputted into image processing software of Surfacer 9.0.RESULTS AND CONCLUSION: The three-dimensional wire frame and solid image of skull was reconstructed and computer aided design for plastic operation was accomplished on it. Then the simulacrum of underlay was obtained by rapid prototyping technology. A three-dimensional skull model could be established using spiral computer tomography data. It might play an important role in the diagnosis and treatment of tumors, injuries and abnormality in craniofacial surgery.

Objective To analyze the clinical characteristic and provide therapeutic techniques of maxillofacial trauma in the elderly. Methods Geriatric maxillaofacial trauma patients admitted to our hospital from January 1992 to December 2002 was retrospectively reviewed. Data were collected according to etiology, location, comorbidities, associated injuries, therapeutic methods and the outcome. The patients were compared with a control group consisting of 200 young and adult patients admitted at the same period. Results For the 126 geriatric trauma patients, the major causes were traffic accidents(61.1%) and violence assault(25.4%). A large proportion of facial injuries occurred on the lower part of the face. 69.1% of the patients presented with preexisting diseases. Most of the fractures were not treated(35.7%). The length of hospitalization and ICU stay were relatively longer when compared with the control group(P

Objective:To establish an animal model in goats for curved mandibular regeneration by distraction osteogenesis(DO).Methods:Four goats were used.Internally installed curved mandibular distractors were activated 6 days after mandibular osteotomy on the mandibular angles or mandibular symphyses at a rate of l mm/d for 25~34 days.The mandibles were examined by roentgenography.Results:The arched defects of the mandibles in the 4 goats were reconstructed by regenerated bone by the end of DO.Conclusion:Internally installed curved distractor may be used for osteogenesis in the repaire of the arched mandibular defects.