Mandibular reconstruction with the titanium hollow screw reconstruction plate (THORP) system: evaluation of 62 cases

The titanium hollow screw reconstruction plate (THORP) system for reconstruction of lower jaw defects provides a functional stable fixation and is used as a long-term or permanent implant in tumor surgery and in traumatology. The rigid fixation of the head of the screw to the plate, avoiding unphysiologic loads to the bone underneath the plate, and the titanium plasma-coated perforated hollow screws, enabling the development of direct bone-titanium contact as well as the ingrowth of bone into the lumen and perforations, are the major advantages of this system compared to conventional systems. The different surgical methods, such as preservation of the condylar process with only two screws, intraoperative freely adjustable condylar prosthesis, lingual application of the plate, and primary bone transplantation, are described. The evaluation of 62 patients reconstructed with the THORP system between 1981 and 1986 revealed no plate loosening, even in irradiated bone, and showed satisfactory aesthetic and functional results.     

Complications after breast reconstruction with alloplastic material in breast cancer patients submitted or not to post mastectomy radiotherapy

Background and purposeBreast reconstruction following mastectomy is a relevant element of breast cancer treatment. The purpose of this study was to evaluate the influence of radiotherapy (RT) on local complications in patients with breast cancer that had undergone breast reconstruction with alloplastic material.Materials and methodsRetrospective study of breast cancer patients submitted to mastectomy and breast reconstruction from 2009 to 2013. Clinical and treatment variables were correlated with early and late complications.Results251 patients were included; mean age was 49.7 (25 to 78) years. Reconstruction was immediate in 94% of the patients, with 88% performed with a temporary tissue expander. Postoperative radiotherapy (RT) was delivered to 167 patients (66.5%). Early complications were present in 26.3% of the patients. Irradiated patients presented 5.4% incidence of late complications versus 2.4% for non-irradiated patients (p = 0.327). Diabetes (OR = 3.41 95% CI: 1.23–9.45, p = 0.018) and high body mass index (BMI) (OR = 2.65; 95% CI: 1.60–4.37, p < 0.0001) were the main risk factors. The overall incidence of late complications was 4.4%, with predominance of severe capsular contracture (8/11). Arterial hypertension (OR = 4.78; 95% CI: 1.97–11.63, p = 0.001), BMI (OR = 0.170; 95% CI: 0.048–0.607, p = 0.006) and implant placement (OR = 3.55; 95% CI: 1.26–9.99, p = 0.016) were related to late complications.ConclusionsThe overall rate of complications was low in this population. Radiotherapy delivery translated into a higher but not statistically significant risk of late complications when compared with the non-irradiated patients. Already well-known clinical risk factors for complications after breast reconstruction were identified.     

Mesozoic plate tectonic reconstruction of the Carpathian region

Palaeomagnetic, palaeobiogeographic and structural comparisons of different parts of the Alpine-Carpathian region suggest that four terranes comprise this area: the Alcapa, Tisza, Dacia and Adria terranes. These terranes are composed of different Mesozoic continental and oceanic fragments that were each assembled during a complex Late Jurassic-Cretaceous-Palaeogene history. Palaeomagnetic and tectonic data suggest that the Carpathians are built up by two major oroclinal bends. The Alcapa bend has the Meliata oceanic unit, correlated with the Dinaric Vardar ophiolite, in its core. It is composed of the Western Carpathians, Eastern Alps and Southern Alcapa units (Transdanubian Range, Bükk). This terrane finds its continuation in the High Karst margin of the Dinarides. Further elements of the Alcapa terrane are thought to be derived from collided microcontinents: Czorsztyn in the N and a carbonate unit (Tisza?) in the SE. The Tisza-Dacia bend has the Vardar oceanic unit in its core. It is composed of the Bihor and Getic microcontinents. This terrane finds its continuation in the Serbo-Macedonian Massif of the Balkans.The Bihor-Getic microcontinent originally laid east of the Western Carpathians and filled the present Carpathian embayment in the Late Palaeozoic-Early Mesozoic. The Vardar ocean occupied an intermediate position between the Western Carpathian-Austroalpine-Transdanubian-High Karst margin and the Bihor-Getic-Serbo-Macedonian microcontinent. The Vardar and Pindos oceans were opened in the heart of the Mediterranean-Adriatic microcontinent in the Late Permian-Middle Triassic. Vardar subducted by the end of Jurassic, causing the Bihor-Getic-Serbo-Macedonian microcontinent to collide with the internal Dinaric-Western Carpathian margin.An external Penninic-Váhic ocean tract began opening in the Early Jurassic, separating the Austroalpine-Western Carpathian microcontinent (and its fauna) from the European shelf. Further east, the Severin-Ceahlau-Magura also began opening in the Early Jurassic, but final separation of the Bihor-Getic ribbon (and its fauna) from the European shelf did not take place until the late Middle Jurassic.The Alcapa and the Tisza-Dacia were bending during the Albian-Maastrichtian. The two oroclinal bends were finally opposed and pushed into the gates of the Carpathian embayment during the Palaeogene and Neogene. At that time, the main N-S shortening in distant Alpine and Hellenic sectors was linked by a broader right-lateral shear zone along the former Vardar suture.     

The use of a fascial flap in ear reconstruction.

We describe the use of a fascial flap for covering the framework in ear reconstruction. When covered in turn with a skin graft, this fascial flap provides an abundant amount of a thin, tough, vascular, hairless cover of good quality in all cases except those where injuries in the auricular area have been deep enough to damage this fascia. This method of ear reconstruction is particularly useful in secondary ear reconstructions useful in secondary ear reconstructions and in reconstruction after traumatic losses. The procedure described can often be performed in one stage, requiring two to 4 hours, with minimal complications.