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http://dx.doi.org/10.5999/aps.2016.43.1.40

Delayed Foreign Body Reaction Caused by Bioabsorbable Plates Used for Maxillofacial Fractures  

Jeon, Hong Bae (Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Dankook University College of Medicine)
Kang, Dong Hee (Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Dankook University College of Medicine)
Gu, Ja Hea (Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Dankook University College of Medicine)
Oh, Sang Ah (Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Dankook University College of Medicine)
Publication Information
Archives of Plastic Surgery / v.43, no.1, 2016 , pp. 40-45 More about this Journal
Abstract
Background Bioabsorbable plates and screws are commonly used to reduce maxillofacial bones, particularly in pediatric patients because they degrade completely without complications after bone healing. In this study, we encountered eight cases of a delayed foreign body reaction after surgical fixation with bioabsorbable plates and screws. Methods A total of 234 patients with a maxillofacial fracture underwent surgical treatment from March 2006 to October 2013, in which rigid fixation was achieved with the Inion CPS (Inion, Tampere, Finland) plating system in 173 patients and Rapidsorb (Synthes, West Chester, PA, USA) in 61 patients. Their mean age was 35.2 years (range, 15-84 years). Most patients were stabilized with two- or three-point fixation at the frontozygomatic suture, infraorbital rim, and anterior wall of the maxilla. Results Complications occurred in eight (3.4%) of 234 patients, including palpable, fixed masses in six patients and focal swelling in two patients. The period from surgical fixation to the onset of symptoms was 9-23 months. Six patients with a mass underwent secondary surgery for mass removal. The masses contained fibrous tissue with a yellow, grainy, cloudy fluid and remnants of an incompletely degraded bioabsorbable plate and screws. Their histological findings demonstrated a foreign body reaction. Conclusions Inadequate degradation of bioabsorbable plates caused a delayed inflammatory foreign body reaction requiring secondary surgery. Therefore, it is prudent to consider the possibility of delayed complications when using bioabsorbable plates and surgeons must conduct longer and closer follow-up observations.
Keywords
Absorbable implants; Foreign body reaction; Maxillofacial injury;
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1 Pietrzak WS, Sarver DR, Verstynen ML. Bioabsorbable polymer science for the practicing surgeon. J Craniofac Surg 1997;8:87-91.   DOI
2 Eppley BL, Morales L, Wood R, et al. Resorbable PLLA-PGA plate and screw fixation in pediatric craniofacial surgery: clinical experience in 1883 patients. Plast Reconstr Surg 2004;114:850-6.   DOI
3 Kwon H, Kim SW, Jung SN, et al. Cellulitis related to bioabsorbable plate and screws in infraorbital rim fracture. J Craniofac Surg 2011;22:625-7.   DOI
4 Kumar AV, Staffenberg DA, Petronio JA, et al. Bioabsorbable plates and screws in pediatric craniofacial surgery: a review of 22 cases. J Craniofac Surg 1997;8:97-9.   DOI
5 Bergsma EJ, Rozema FR, Bos RR, et al. Foreign body reactions to resorbable poly(L-lactide) bone plates and screws used for the fixation of unstable zygomatic fractures. J Oral Maxillofac Surg 1993;51:666-70.   DOI
6 Miller RA, Brady JM, Cutright DE. Degradation rates of oral resorbable implants (polylactates and polyglycolates): rate modification with changes in PLA/PGA copolymer ratios. J Biomed Mater Res 1977;11:711-9.   DOI
7 Laughlin RM, Block MS, Wilk R, et al. Resorbable plates for the fixation of mandibular fractures: a prospective study. J Oral Maxillofac Surg 2007;65:89-96.
8 Rha EY, Paik H, Byeon JH. Bioabsorbable plates and screws fixation in mandible fractures: clinical retrospective research during a 10-year period. Ann Plast Surg 2015;74:432-6.   DOI
9 Sevastjanova NA, Mansurova LA, Dombrovska LE, et al. Biochemical characterization of connective tissue reaction to synthetic polymer implants. Biomaterials 1987;8:242-7.   DOI
10 Bergsma JE, de Bruijn WC, Rozema FR, et al. Late degradation tissue response to poly(L-lactide) bone plates and screws. Biomaterials 1995;16:25-31.   DOI
11 Rubin JP, Yaremchuk MJ. Complications and toxicities of implantable biomaterials used in facial reconstructive and aesthetic surgery: a comprehensive review of the literature. Plast Reconstr Surg 1997;100:1336-53.   DOI
12 Orringer JS, Barcelona V, Buchman SR. Reasons for removal of rigid internal fixation devices in craniofacial surgery. J Craniofac Surg 1998;9:40-4.   DOI
13 Wiltfang J, Merten HA, Schultze-Mosgau S, et al. Biodegradable miniplates (LactoSorb): long-term results in infant minipigs and clinical results. J Craniofac Surg 2000;11:239-43.   DOI
14 Imola MJ, Hamlar DD, Shao W, et al. Resorbable plate fixation in pediatric craniofacial surgery: long-term outcome. Arch Facial Plast Surg 2001;3:79-90.   DOI
15 Mackool R, Yim J, McCarthy JG. Delayed degradation in a resorbable plating system. J Craniofac Surg 2006;17:194-7.   DOI
16 Katsuragi YT, Gomi A, Sunaga A, et al. Intracerebral foreign body granuloma caused by a resorbable plate with passive intraosseous translocation after cranioplasty. J Neurosurg Pediatr 2013;12:622-5.   DOI
17 Bell RB, Kindsfater CS. The use of biodegradable plates and screws to stabilize facial fractures. J Oral Maxillofac Surg 2006;64:31-9.
18 Xue AS, Koshy JC, Weathers WM, et al. Local foreign-body reaction to commercial biodegradable implants: an in vivo animal study. Craniomaxillofac Trauma Reconstr 2014;7:27-34.   DOI