Titanium plating is recognized as the criterion standard for the treatment of mandibular fractures and osteotomies. Use of resorbable implants is well documented in the literature for a range of craniofacial fractures. However, no clear review exists of the use of resorbable implants on the mandible. In this systematic review, we searched MEDLINE/PubMed and the Cochrane Database for studies of resorbable mandibular fixation. Two independent reviewers analyzed the search results using specific inclusion/exclusion criteria. Twenty-two articles detailing 19 studies, including 1 randomized controlled trial were analyzed in this study. These studies included fixation of mandibular fractures at various locations or fixation of bilateral sagittal split osteotomies. Overall, we found a total of 326 patients treated with resorbable plates and screws and 112 patients treated with resorbable screws alone. Analysis of these studies indicates that several material types are used in resorbable mandibular implants, including poly-L-lactic acid (PLLA) and 70% poly-L-lactic acid/30% poly-D,L-lactic acid (PLLA 70/PDLLA 30), coming from at least 10 different manufacturers. Mean follow-up ranged from 3 to 348 weeks. Based on the reported data, we found a total of 14 to 15 infections, 2 foreign body reactions, 7 malocclusions, 8 malunions, and 8 to 10 premature removals in the plate group and 1 foreign body reaction and 2 malocclusions in the screws-only group. These results should be interpreted in the context of the patient selection criteria in the studies. This systematic review demonstrates the need for further randomized controlled trials in this area and concludes with such a study design.
Primary closure of the abdominal wall after combined liver and intestine transplantation from a living donor into a pediatric patient is usually not possible, because of the size of the donor organ, graft edema, and preexisting scars or stomas of the abdominal wall. Closure under tension may lead to abdominal compartment syndrome with vascular compromise and necrosis of the transplanted organ. We describe our experience of abdominal wound closure after liver and intestinal transplant in the pediatric patient using a staged approach. From February 2003 to June 2006, we managed five pediatric liver and intestinal living donor transplant recipients. Because of the large post-transplantation abdominal wall defect, a staged technique of abdominal wound closure was utilized. Initially, an absorbable Polygalactin mesh was sutured around the layer of the defect. As soon as adequate granulation tissue was formed over the mesh a STSG was applied. From the wound stand point all five patients were managed successfully with staged wound closure after transplantation. Granulation tissue filled and covered the mesh within 7.6 wk. A STSG was then used to cover the defect. All infants recovered well and none had a significant wound complication in the immediate post-operative period following STSG. At a mean follow-up of 24 months only one patient developed an entero-cutaneous fistula five months post-transplant. Staged abdominal wall coverage with the use of Polygalactin mesh followed by STSG is a simple and effective technique. A closed wound is achieved in a timely fashion with protection of the viscera. Residual ventral hernia will need to be managed in the future with one of several reconstructive techniques.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.