Surgical Outcomes Using Bioabsorbable Plating Systems in Pediatric Craniofacial Surgery

Tharanon, Wichit; Sinn, Douglas P.; Hobar, P. Craig; Sklar, Frederick H.; Salomon, Jhonny

doi:10.1097/00001665-199809000-00008

Cited by 66 publications

(22 citation statements)

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“…Generally, complications encountered with ultrasound activated resorbable pin osteosynthesis do not seem to differ from that of conventional resorbable osteosynthesis 27 . The three patients who required reoperation for the removal of the remnants of the resorbable plates, were treated on an outpatient basis.…”

Section: Discussionmentioning

confidence: 93%

Prospective assessment of complications associated with ultrasound activated resorbable pin osteosynthesis in pediatric craniofacial surgery: preliminary results

Nkenke¹,

Vairaktaris²,

Schwarz³

et al. 2011

Neurocirugía

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SummaryUltrasound activated resorbable pin osteosynthesis (UARPO) has recently shown favourable results in operations on children suffering for craniosynostosis. However, data on complications coming with this new technique in children suffering from craniosynostoses are scarce and have only been assessed retrospectively so far. It has been the aim of the present study to prospectively follow up children undergoing craniosynostosis surgery with a focus on complications related to UARPO materials.Ten pediatric patients (3 female/7 male) were operated due to craniosynostosis at an average age of 9.1±3.8 months using UARPO (SonicWeld/Resorb-X, KLS Martin, Tuttlingen, Germany). Clinical followup evaluations were carried out 1, 3, 6, 9, 12 and 18 months after surgery according to signs of local infection, stability of the remodeled cranial vault and the palpability of the osteosynthesis material. If secondary surgery was necessary, the indication was documented and evaluated by histological and wound smear examinations.No intra-operative or postoperative complications during the inpatient period occurred. 3 patients needed secondary operation due to a localized chronic swelling at the former incision site which developed 3, 9 and 12 months after the operation. Histological examinations yielded a giant cell formation surrounding the resorbable materials in all cases. Additionally, the wound smear showed a bacterial infection in one site.The current prospective study is the first in the field. It reveals a high percentage of delayed foreign body reactions with UARPO, bearing the need of secondary surgery. It seems that this high complication rate found in the present prospective study may weigh out the advantages of UARPO.KEY WORDS. Craniofacial surgery. Craniosynostosis. Resorbable materials. Ultrasound activated resorbable pin osteosynthesis.Estudio prospectivo evaluando complicaciones de cirugía craneofacial pediátrica usando clavos reabsorbibles activados con ultrasonidos: resultados preliminares Resumen Recientemente, la osteosíntesis activada por ultrasonografía con clavos reabsorbibles (OAURC) ha demostrado resultados favorables con operaciones en niños que sufren de craneosinostosis. Sin embargo, los datos actuales sobre complicaciones provenientes con esta técnica nueva en niños que sufren de craneosinostosis son escasos, hasta ahora estos datos solamente han sido evaluados retrospectivamente. El propósito de este estudio, es el seguimiento prospectivo de aquellos niños sometidos a cirugía por craneosinostosis, enfocándose específicamente en complicaciones relacionadas con el uso de los materiales aplicando OAURC.Diez pacientes pediátricos (3 femeninos/7 masculinos) fueron operados utilizando OAURC (SonicWeld/ Resorb-X, KLS Martin, Tuttlingen, Alemania) debido a craneosinostosis; la edad promedio de esos pacientes fue de 9.1±3.8 meses. Se llevaron a cabo examinaciones clínicas de seguimiento 1, 3, 6, 9, 12 y 18 meses después de la cirugía buscando señas de infección local, estabilidad de la bóveda craneoencefá...

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Section: Discussionmentioning

confidence: 93%

Prospective assessment of complications associated with ultrasound activated resorbable pin osteosynthesis in pediatric craniofacial surgery: preliminary results

Nkenke¹,

Vairaktaris²,

Schwarz³

et al. 2011

Neurocirugía

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“…In a number of studies involving PLA-PGA plates for head and neck surgery including craniofacial reconstruction and maxillary fracture fixation, no inflammatory responses were encountered. 14,15,28,33 Although no clinical evidence of inflammation or discomfort was noted in the goats by 12 weeks, histologically 50% of the PLA-PGA cage-implanted interspaces developed a foreign body granuloma, apparently elicited by PLA-PGA copolymeric debris and degradation byproducts. Whether a copolymer composition ratio with a higher PLA content, and consequently slower degradation rate, would elicit less fibroplasia or inflammation and thereby permit bone growth through the cage to achieve arthrodesis, may be worthy of future evaluations.…”

Section: Discussionmentioning

confidence: 89%

“…5,9,11,17,22,23,26,27 These resorbable polymers have also been fashioned into plates for use in neurosurgical and maxillofacial procedures. 14,15,28,33 Investigators conducting studies in animal models of the cervical spine have used dogs or goats, 13,24,25,29,32,[35][36][37][38] some with high rates of graft fracture and extrusion. 13,25 The geometrical shape of the disc space in the goat approximates…”

mentioning

confidence: 99%

Suitability of bioresorbable cages for anterior cervical fusion

Cahill¹,

Martin²,

Hajjar³

et al. 2003

Journal of Neurosurgery: Spine

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Object. The authors conducted a pilot study to determine whether a bioresorbable intervertebral fusion device composed of 85/15 polylactide—polyglycolide (PLA-PGA) copolymer packed with bone autograft is a suitable alternative to promote arthrodesis after anterior cervical discectomy (ACD) in a caprine model. Methods. The caprine cervical spine model has been used to evaluate interbody healing and fusion after application of bone grafts and instrumentation. Whether a bioresorbable device is suitable for facilitating intervertebral bone union has not been determined. Twelve goats underwent two-level ACD and fusion; eight received bioresorbable cages packed with autologous bone, and four received autologous bone alone. Goats were maintained without an orthosis and after 12 weeks underwent physical, radiographic, and histological evaluation. Cages had structurally degraded, and two had become extruded. Stable intervertebral union developed in three (19%) of 16 cage-implanted interspaces, and one (14%) of seven bone autograft—implanted interspaces; each was judged manually to be rigid (Grade 2), radiographically to be bridged by new osseous densities (Grade 2), and histologically to have marked new bone formation (Grade 3). A primarily fibrous union, however, stabilized the cage-implanted interspaces, and eight (50%) had developed a 4 to 6—mm foreign body granuloma. These interposed soft tissues were not present in the stable autologous bone—implanted interspace, which had successfully become fused. Conclusions. Interbody cages composed of 85/15 PLA-PGA copolymer contributed to a stable fibrous union, degraded, and produced granuloma after 12 weeks. Additional evaluations are necessary to determine whether other copolymer mixtures, or other bioresorbable materials, can contribute to an arthodesis without deleterious consequences.

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“…Sin embargo, la aparición en el mercado del material bioreabsorbible como sistema de osteosíntesis ha supuesto una excelente alternativa al titanio para la fijación ósea semirrígida craneomaxilofacial 5 , sobre todo en pacientes pediátricos porque no es necesario retirarlos ni interfieren con el crecimiento craneofacial 24 . Así, en nuestra serie es el método de osteosíntesis más utilizado desde el comienzo de su uso a partir de 1998, en un total de 45 casos (51,72%).…”

Section: Discussionunclassified

Orbitotomías óseas mediante abordaje coronal: estudio retrospectivo de 87 lesiones intraorbitarias

et al. 2008

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Recibido:322 Neurocirugía 2008; 19: Resumen Objetivo. Presentar nuestra experiencia en 80 pacientes con tumores y lesiones intraorbitarias en los que se realizaron 87 orbitotomías óseas mediante abordaje coronal, durante un período de 12 años.Material, métodos y resultados. El diagnóstico histológico más frecuente fue el hemangioma, y la localización anatómica más frecuente la retrobulbar intracónica. La presentación bilateral de lesiones ocurrió en 7 pacientes. Las orbitotomías más utilizadas fueron la lateral y supero-lateral (87,35%). En un 90,80% de los casos se realizó algún tipo de osteosíntesis, un 51,75% con placas bio-reabsorbibles. La exposición o rotura de la duramadre intraoperatoria ocurrió en 10 pacientes. Se recogieron 45 complicaciones postoperatorias transitorias y 21 permanentes, las más frecuentes fueron las nerviosas (diplopia y ptosis) que se resolvieron espontáneamente en su mayoría en un corto intervalo de tiempo. En 15 pacientes se requirió colaboración multidisciplinar con neurocirugía.Conclusiones. La incisión coronal permite realizar cualquier orbitotomía ósea con seguridad, garantía y buen resultado estético y funcional. Las orbitotomías lateral y supero-lateral proporcionan un abordaje ideal extradural al espacio retrobulbar. El acceso al ápex, canal orbitario y zona medial nervio óptico requiere comúnmente un abordaje combinado neuroquirúrgico a través de fosa craneal anterior. La fijación de las orbitotomías mediante osteosíntesis biorreabsorbible constituye una alternativa a las placas de titanio, incluso puede ser de primera elección en la edad pediátrica. La morbilidad de esta cirugía es baja.PALABRAS CLAVE: Órbita. Tumor. Cirugía de órbita. Incisión bicoronal. Orbitotomía. Placa reabsorbible. Osseous orbitotomies using a coronal flap: A retrospective study of 87 intraorbital lesions SummaryObjective. To present our experience in 80 patients with intraorbital tumours and lesions who underwent 87 osseous orbitotomies with coronal incision during a 12 year period.Material, methods and results. Hemangioma was the most frequent histologic diagnosis, being the intraconical retrobulbar compartment the most common location. Bilateral presentation of lesions occurred in 7 patients. Lateral and supero-lateral orbitotomies were preferably applied (87.35%). In 90.80% of cases some kind of osteosynthesis was employed, 51.75% with bio-resorbable plates. Intraoperative exposure or dura mater breakage occurred in 10 patients. 45 transitory and 21 permanent postoperative complications were seen, being the nervous ones (diplopia and ptosis) the most frequent. Most of these were spontaneously solved in a short time period. 15 patients required multi-disciplinary collaboration with neurosurgery.Conclusions. Coronal incision allows any bone orbitotomy, with security, guarantee and good aesthetic and functional results. Lateral and supero-lateral orbitotomies provide an ideal extradural approach to the retrobulbar compartment. An approach to the apex, orbital channel and medial compartment to th...

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Surgical Outcomes Using Bioabsorbable Plating Systems in Pediatric Craniofacial Surgery

Cited by 66 publications

References 0 publications

Prospective assessment of complications associated with ultrasound activated resorbable pin osteosynthesis in pediatric craniofacial surgery: preliminary results

Prospective assessment of complications associated with ultrasound activated resorbable pin osteosynthesis in pediatric craniofacial surgery: preliminary results

Suitability of bioresorbable cages for anterior cervical fusion

Orbitotomías óseas mediante abordaje coronal: estudio retrospectivo de 87 lesiones intraorbitarias

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