A Wrapping Method for Inserting Titanium Micro-Mesh Implants in the Reconstruction of Blowout Fractures

Abstract

Titanium micro-mesh implants are widely used in orbital wall reconstructions because they have several advantageous characteristics. However, the rough and irregular marginal spurs of the cut edges of the titanium mesh sheet impede the efficacious and minimally traumatic insertion of the implant, because these spurs may catch or hook the orbital soft tissue, skin, or conjunctiva during the insertion procedure. In order to prevent this problem, we developed an easy method of inserting a titanium micro-mesh, in which it is wrapped with the aseptic transparent plastic film that is used to pack surgical instruments or is attached to one side of the inner suture package. Fifty-four patients underwent orbital wall reconstruction using a transconjunctival or transcutaneous approach. The wrapped implant was easily inserted without catching or injuring the orbital soft tissue, skin, or conjunctiva. In most cases, the implant was inserted in one attempt. Postoperative computed tomographic scans showed excellent placement of the titanium micro-mesh and adequate anatomic reconstruction of the orbital walls. This wrapping insertion method may be useful for making the insertion of titanium micro-mesh implants in the reconstruction of orbital wall fractures easier and less traumatic.

Considerations for the Management of Medial Orbital Wall Blowout Fracture

“…Titanium has been used extensively in the craniofacial surgery and dentistry fields in the form of implants, plates, and screws. Titanium is biocompatible, has excellent physico-mechanical properties, and is strong, rigidly fixable, widely available, relatively familiar to surgeons, and is osseointegrated with minimal foreign body reaction [ 47 ], and thus, it could be an ideal implant for covering large anatomical defects. However, titanium is costly and if not cut properly may have irregular edges that impinge on soft tissues.…”

Clinical comparison of different flap advancement techniques to periosteal releasing incision in guided bone regeneration: A randomized controlled trial

“…Nevertheless, the well‐documented incidence of exposure could reach up to 50% of the cases represent a challenge 4‐6 . The aforementioned exposure is attributed to the presence of sharp edges which may cause injury to the surrounding tissues 7 and the tendency to revert to their original shape after being molded to cover the defect. Tension‐free primary closure is mandatory in all augmentation procedures and can be achieved through sufficient flap advancement 8 .…”