Three-dimensional Titanium Mesh Research Articles

Decompressive Bone Flap Replacement (Decompressive Cranioplasty): A Novel Technique for Intracranial Hypertension-Initial Experience and Outcome.

Intracranial hypertension is a life-threatening condition that can be treated by decompressive craniectomy (DC), which involves removing a part of the skull and intracranial lesions. However, DC has many complications and requires a second surgery to repair the skull. Decompressive bone flap replacement (DBFR) or decompressive cranioplasty is a novel technique that replaces the bone flap with a titanium mesh, providing both decompression and skull integrity. The materials and methods of DBFR are described in detail. A three-dimensional titanium mesh is fabricated based on the computed tomography (CT) data of previous DC patients. An appropriate titanium mesh is selected based on the preoperative and intraoperative assessments. After removing the intracranial lesions, the titanium mesh is fixed over the bone window. We successfully performed DBFR in three emergent cases. The postoperative CT scan showed adequate decompression in all cases. No reoperation for skull repair was needed, and there were no surgical complications. The cosmetic outcome was excellent. There were no relevant complications in the operative area. DBFR may be a safe and effective alternative to DC in a specific subgroup of patients, in whom complete removal of the bone flap is feasible. DBFR can reduce intracranial pressure while maintaining the integrity of the skull cavity, eliminating the need for additional surgery for skull repair. Possible improvements for DBFR in the future are suggested, such as using a greater curvature of the titanium mesh or a modified DBFR with a hinged titanium mesh.

Three-dimensional titanium mesh-based flow electrode capacitive deionization for salt separation and enrichment in high salinity water

Flow electrode capacitive deionization (FCDI) is a highly promising desalination technique known for its exceptional electrosorption capacity, making it suitable for efficient salt separation in high salinity water. However, the unsatisfactory charge transfer process between the flow electrode and current collector severely curtails the salt separation and enrichment performance of the FCDI device. To address this issue, three-dimensional titanium mesh (3D-TM) was proposed as a novel current collector for FCDI device, which significantly amplifies the charge transfer area and exhibits excellent salt separation performance. The 3D-TM current collector promotes the electron transfer, charge percolation, and ion migration processes through the electroconvection generated by the turbulence effect on the flow electrode. In the specific case of the 20-mesh 3D-TM, which is composed of 12 stacking layers of titanium mesh, the remarkable average salt removal rate and charge efficiency were achieved 5.06 μmol cm−2 min−1 and 92.9 % under an appropriate applied voltage of 2.0 V, respectively. Dramatically, the desalination performance maintained above 76.4 % over 100 desalination cycles at 2.0 V, demonstrating the exceptional cyclic stability of the 3D-TM FCDI cell. In the seawater desalination, the 3D-TM FCDI cell exhibited an impressive salt removal efficiency of 97.5 % (from 34.2 g L−1 to 0.84 g L−1) for 1 L East China seawater at 2.0 V for 24 h. For lithium-ion enrichment, the FCDI continuous desalting system achieved an astonishing concentration of 17.3 g L−1 for Li+ ions enrichment from an initial concentration of 1.30 g L−1, obtaining the average salt treating rate of 23.6 g m−2h−1 and charge efficiency of 80.0 %. Moreover, the lithium-sodium ions and lithium-magnesium ions enrichments were both conducted, yielding an enriched concentration of 10.4 g L−1 and 7.30 g L−1 for Li+ ions, respectively. These findings highlight the enormous potential of FCDI technology in industrial engineering applications, further establishing it as a highly viable solution.

20-year Results of a 3D Titanium Mesh Coating Stability of 31 Artificial Cups.

The aim of this work was to demonstrate the bony bond strength and resilience of a three-dimensional titanium mesh coating of an artificial acetabulum produced using the diffusion bonding technique. Under the extreme conditions ranging from abrasion-related osteolysis to acetabular perforation, the degree of residual bone and the integrity of the coating were determined. The remaining zones of the (still) stable bone connection are inevitably exposed to a greater load of the layer adhesion between the titanium mesh and the core shell. The investigation was intended to provide information about the stages of damage according to Paprosky in which it was still justifiable to leave the implant in place and simply change the inlay from the purely material-technical point of view of a stable coating. The bond between bone and implant was examined with regard to a possible retention of the implant for its adaptive remodeling up to 27 years. In a retrospective study, 31 explanted human acetabular cups of the Harris-Galante II type, with an average lifetime of 19.7 years (11-27 years), were examined by means of digital area measurement to determine both the bone areas remaining on the coating and the damaged areas of the titanium mesh. Periacetabular bone loss was recorded in a modified Paprosky (PAP) damage classification. Full hemispherical sections of 4 acetabular cups with a life time of 16, 20, 22 and 27 years were examined histopathologically using the diamond cut technique. The periacetabular bone loss resulted in damage class PAP I in 8 cases, PAP IIa in 7 cases, PAP IIb in 2 cases, PAP IIc in 9 cases, PAP IIIa in 3 cases and PAP IIIa in 2 cases PAP IIIb. The average amount of bone that was still firmly attached to the coating after explantation was 17% (0-70%) of the total cup surface. Paprosky I accounted for 44.1%, and PAP IIa and IIb stadiums together a total of 17.1%. The average bone fraction of the implants no longer anchored in the host bed at stages IIc, IIIa and IIIb was 2%. The average coating damage was 11% (0-100%) and was exclusively attributable to the unstable implants of stages IIc, IIIa and IIIb. The histopathological findings showed adaptive bone remodeling, that was detectable for up to 27 years through the titanium mesh down to the interface with the solid acetabular core. The titanium wire mesh was mostly surrounded by lamellar, mature bone. The results show that the connection between the Tivanium cup and the previously oldest and unchanged sintered coating - in the form of a three-dimensional titanium mesh applied in point and line contact - is very load-resistant even under the extreme loads of periacetabular osteolysis and cup perforations. Since there was no damage to the coating in periacetabular damage stages Paprosky I, IIa and IIb, it is justifiable in these damage stages to leave the implant in situ and to continue to use it with sole replacement of the inlay, but leaving the socket shell. The third-generation acetabular cup (Trilogy) with unchanged three-dimensional titanium mesh coating has been implanted in over 1.2 million cases for 26 years. After a long service life, an increasing number of wear and tear conditions can be expected in today's mostly elderly and vulnerable patient clientele. In view of the results presented here, the early detection of damage would make it possible to avoid costly and stressful explantation of the entire acetabular cup in favor of replacing the sole inlay in Paprosky stages I, IIa and IIb.

A Novel Titanium Cranioplasty Technique of Marking the Coronal and Squamosoparietal Sutures in Three-Dimensional Titanium Mesh as Anatomical Positioning Markers to Increase the Surgical Accuracy and Reduce Postoperative Complications.

Objective: The objective of this research is to modify the titanium cranioplasty (Ti-CP) technique to increase the surgical accuracy and preliminarily verify the effectiveness and safety of this improvement.Methods: We developed a novel technique of marking the coronal and squamosoparietal sutures in three-dimensional (3D) titanium mesh as anatomical positioning markers and designed a prospective trial in patients with a unilateral frontotemporoparietal skull defect. Patients were randomly divided into two groups by the presence or absence of the anatomical positioning markers, and the therapeutic effects of these two groups were compared.Results: Forty-four patients were included in this study, including 28 (64%) males and 16 (36%) females. The mean age was 44.8 ± 15.2 years (range, 13–75 years). Overall postoperative complication rate of the intervention group (18%) was significantly (P = 0.03) lower than the control group (50%). Surgical accuracy of the intervention group (97.8%) was significantly (P < 0.001) higher than the control group (94%). Visual analog scale for cosmesis (VASC) of the intervention group (8.4) was significantly (P < 0.001) higher than the control group (7). The overall postoperative complication rate was 34%. Multivariate analyses showed that surgical accuracy <95.8% (OR = 19.20, 95% CI = 3.17–116.45, P = 0.001) was significantly associated with overall postoperative complications. Independent predictor of overall postoperative complications was surgical accuracy (OR = 0.57, 95% CI = 0.40–0.82, P = 0.002).Conclusions: This novel technique for repairing frontotemporoparietal skull defects increases surgical accuracy, improves cosmetic prognosis, and reduces postoperative complications. Therefore, it is a safe and effective improvement for Ti-CP.

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.

Analysis of the effect of three-dimensional titanium mesh repair at different stages after decompression of craniectomy for intracerebral hemorrhage

Objective To investigate the effects of three-dimensional titanium mesh repair on cerebral perfusion, intracranial pressure and nerve function after decompression with bone flap. Methods From October 2015 to October 2018, 132 hypertensive cerebral hemorrhage patients of bone disc decompression in the Fifth People's Hospital of Jinan were selected and divided into observation group(66 cases) and control group(66 cases) by double blind random method .The observation group received three-dimensional titanium mesh repair at 24 ~ 42 d after bone disc decompression surgery.The control group received three-dimensional titanium mesh repair at 90 ~ 150 d(3 ~ 5 months) after surgery.The changes of operation, cerebral perfusion, intracranial pressure and nerve function were compared between the two groups. Results The operative time, blood loss and free time of the flap in the observation group were (92.5±12.4)min, (354.3±17.5)mL and (13.2±3.1)min, respectively, which were shorter or less than those in the control group [(142.8±15.3)min, (518.3±22.3)mL and (38.3±4.3)min], the differences between the two groups were statistically significant(t=4.745, 6.831, 4.963, all P<0.05). After treatment, the abnormal indices of intracranial pressure and cerebral perfusion in the observation group were (0.1±0.0) and (0.2±0.1), respectively, which were lower than those in the control group[(0.2±0.1), (0.3±0.1)] (t=3.657, 2.579, all P<0.05). There were statistically significant differences in neurological deficit scores between the two groups at different time points(all P<0.05). The incidence of treatment complications in the observation group was 10.94%(7/64), which was significantly lower than that in the control group [38.7%(24/62)](χ2=14.094, P<0.05). Conclusion Three-dimensional titanium mesh repair is helpful to shorten the operation time, restore the intracranial pressure on the affected side, improve the abnormal cerebral perfusion, and reduce the neurological damage in patients with hypertensive cerebral hemorrhage. Key words: Intracranial hemorrhage, hypertensive; Decompression, surgical; Skull defect; Neural prostheses; Cerebral perfusion; Intracranial pressure; Neurological function; Postoperative complications

Analysis of Complications After Cranioplasty with a Customized Three-Dimensional Titanium Mesh Plate

To report outcomes of cranioplasty (CP) with a customized three-dimensional (3D) titanium mesh plate and identify the relationship between various clinical variables and complications after CP. Twenty patients who underwent surgery with customized 3D titanium mesh plates and had follow-up for >6 months from January 2015 to December 2017 were enrolled. Complications related to CP were retrospectively reviewed. Patients were divided into 2 groups (no complication group and complication group), and clinical variables related to complications were compared between the 2 groups. Correlation analysis was performed to identify the clinical variable significantly correlated with complications after CP with a customized 3D titanium mesh plate. Of 20 patients, 11 developed complications, including extrusion, intracranial infection, severe operative site pain, and wound dehiscence. Among the clinical variables, only the presence of a ventriculoperitoneal shunt was significantly correlated with the overall complication rate (odds ratio= 18.66; 95% confidence interval, 1.56-222.92; P= 0.021). A customized 3D titanium mesh plate is associated with a lower risk of intracranial infection, but the rate of postoperative complications, mainly cosmetic problems, such as forehead mesh extrusion and dehiscence, was high at 55%. A ventriculoperitoneal shunt was significantly correlated with the overall complication rate after CP with a customized 3D titanium mesh plate.

Application of modified three-dimensional titanium mesh in skull repair

Objective To explore the role of the improved computer aided design of the digital three-dimensional titanium mesh in the repair of skull, to reduce the incidence of postoperative epidural hematoma and epidural fluid. Methods Retrospective analysis of 93 cases of skull repair using the three-dimensional titanium mesh was conducted.49 cases in the conventional group used the conventional three-dimensional titanium mesh.44 cases in the observation group were given the improved three-dimensional titanium mesh.The clinical effect of the two groups was observed. Results In the conventional group, postoperative epidural hematoma occurred in 4 cases, 1 case of epidural fluid.All patients were fine in the observation group.The improved three-dimensional titanium mesh could reduce the incidence of epidural hematoma and effusion(χ2=4.745, P=0.029). The conventional group and the observation group both had one case of infection after operation, there was no significant difference between the two groups(χ2=0.001, P=1.000). Conclusion The improved three-dimensional titanium mesh can effectively reduce the incidence of postoperative complications and improve the curative effect of the operation. Key words: Repair of skull; Three-dimensional titanium mesh; Hematoma, epidural, cranial

Soft-Tissue Manipulation Contributes to Craniofacial Symmetry as Importantly as Does Implant Reconstruction in Cranioplasty for Skull Defects

Soft-Tissue Manipulation Contributes to Craniofacial Symmetry as Importantly as Does Implant Reconstruction in Cranioplasty for Skull Defects

New Reconstructive Technologies after Decompressive Craniectomy in Traumatic Brain Injury: The Role of Three-Dimensional Titanium Mesh

Functional and aesthetic reconstruction after wide decompressive craniectomy directly correlates with subsequent quality of life. Advancements in the development of biomaterials have now made three-dimensional (3-D) titanium mesh a new option for the repair of skull defects after craniectomy. The purpose of this study was to review aesthetic and surgical outcomes and complications of patients who had skull defects repaired with 3-D titanium mesh. The records of 40 adult patients (31 unilateral craniectomies and 9 bilateral craniectomies) who underwent a computer-assisted designed titanium mesh implant at a university hospital from January 2008 to January 2010 were retrospectively reviewed. Aesthetic outcomes, cranial nerve V and VII function, and complications (hardware extrusions, meningitis, osteomyelitis, brain abscess, and pneumocephalus) were evaluated. The craniofacial symmetry, implant stability, and functional outcomes were excellent for all patients. No patients had trigeminal or facial dysfunction. All had excellent cosmetic results as measured by post-reduction radiographs and personal and family perceptions of the forehead contour. Two patients had delayed wound healing and subsequent subclinical wound infections, which resolved after treatment with antibiotics for 2 weeks. Craniofacial skeletal reconstruction with 3-D titanium mesh results in excellent forehead contour and cosmesis, and subsequently a better quality of life with few complications. Titanium mesh reconstruction offers a favorable alternative to other graft materials in the repair of large skull defects.

A Comprehensive Algorithm for Anterior Skull Base Reconstruction after Oncological Resections

To present our method for anterior skull base reconstruction after oncological resections. One hundred nine patients who had undergone 120 anterior skull base resections of tumors (52 malignant [43%], 68 benign [57%]) via the subcranial approach were studied. Limited dural defects were closed primarily or reconstructed using a temporalis fascia. Large anterior skull base defects were reconstructed by a double-layer fascia lata graft. A split calvarial bone graft, posterior frontal sinus wall, or three-dimensional titanium mesh were used when the tumor involved the frontal, nasal, or orbital bones. A temporalis muscle flap was used to cover the orbital socket for cases of eye globe exenteration, and a rectus abdominis free flap was used for subcranial-orbitomaxillary resection. Pericranial flap wrapping of the frontonaso-orbital segment was performed to prevent osteoradionecrosis if perioperative radiotherapy was planned. The incidence of cerebrospinal fluid (CSF) leak, intracranial infection, and tension pneumocephalus was 5%. Histopathological and immunohistochemical analysis of fascia lata grafts in reoperated patients (n = 7) revealed integration of vascularized fibrous tissue to the graft and local proliferation of a newly formed vascular layer embedding the fascial sheath. A double-layer fascial graft alone was adequate for preventing CSF leak, meningitis, tension pneumocephalus, and brain herniation. We describe a simple and effective method of anterior skull base reconstruction after resections of both malignant and benign tumors.