• Archives of Plastic Surgery
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• v.38 no.6
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• pp.875-878
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• 2011

Purpose: Absorbable implants are frequently used to fix facial bone fractures, because they are radiolucent and compatible with magnetic resonance imaging (MRI). Despite their increasing usage, however, there have been few reports about their long-term side-effects. In this paper, a case in which absorbable implants led to a foreign body reaction 17 months after their insertion is presented. Methods: A previously healthy 19-year-old male fell from a flight of stairs and visited the authors' hospital with right periorbital pain. Zygomaticomaxillary fracture involving right orbital floor was detected via a facial bone computed tomography (CT). Internal fixation with absorbable implants was followed by open reduction. 17 months after the surgery, the patient complained of localized periorbital swelling. Removal of the granulomatous lesion including the absorbable implants along with their biopsy and culture was performed. Results: The granulomatous lesion around the implants was firm and extended into the maxillary sinus. The histologic finding showed a microabscess with a foreign body reaction. Methicillin-sensitive Staphylococcus aureus growth was confirmed in the culture. No definite abnormal symptoms ensued after the complete removal. Conclusion: A microabscess-forming granulomatous lesion around the absorbable implant can cause delayed symptomatic foreign body reaction despite its rare occurrence. Complete removal of the lesion including implants is expected to have a successful outcome if it is encountered.

• Archives of Craniofacial Surgery
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• v.20 no.4
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• pp.233-238
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• 2019

Background: The open reduction of craniofacial bone fractures requires internal fixation using metal plates and screws, which have been considered the gold standard. However, metal implants pose a risk of palpation, protrusion, and foreign body reaction, and they may require an additional operation for removal. Recently, good results have been reported for absorbable implants which complement the disadvantages of metal implants. This study presents the results of using absorbable mesh, plates, and screws with cyanoacrylate for more accurate and firmer fixation of comminuted fractures of the maxilla. Methods: In total, 235 patients underwent operations for comminuted fractures of the maxilla. From January 2012 to December 2014, absorbable mesh and screws were used in 114 patients, while from January 2015 to December 2017, absorbable mesh, plates, and screws with cyanoacrylate were used in 121 patients. Open reduction of the bone fragments was performed, after which absorbable implants were accurately molded and fixed by screws. Results: All patients underwent postoperative computed tomography scans, which showed highly accurate reduction and firm fixation in the patients who underwent procedures using absorbable implants, screws, and cyanoacrylate. There were no postoperative complications or cases of abnormal facial contour. Conclusion: When absorbable implants and screws are used for maxillary fractures, no additional surgery to remove the metal plate is required. In addition, the use of cyanoacrylate enables accurate and firm fixation of the tiny bone fragments that cannot be fixed with screws.

• Archives of Craniofacial Surgery
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• v.10 no.1
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• pp.23-28
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• 2009

Purpose: Blow out fracture can present tenderness, swelling, enophthalmos, extraoccular muscle limitation, paresthesia, diplopia according to severity of injury, so reconstruction of blow out fracture is important. Orbital soft tissue should be in orbit and defected orbital wall should be corrected by autologus tissue or alloplastic implants. Every implants have their merits and faults, every implants are used various. This study was designed to compare the sequelae of blow-out fracture repair using the alloplastic implants: micro-titanium mesh(Micro Dynamic titanium $mesh^{(R)}$, Leibinger, Germany), porous polyethylene ($Medpor^{(R)}$, Porex, USA), absorbable mesh plate(Biosorb $FX^{(R)}$ . Bionx Implants Ltd, Finland). Methods: Between January 2006 and April 2008, 52 patients were included in a retrospective study analysing the outcome of corrected inferior orbital wall fracture with various kind of implants. Implants were inserted through subciliary incision. Twenty patients were operated with micro-titanium mesh, fourteen patients with porous polyethylene and eighteen patients with absorbable mesh plate. In comparative category, enophthalmos, diplopia, range of motion of extraoccular muscle, inferior orbital nerve injury were more on frequently statistically in patients. Results: Fourteen of 18 patients underwent surgical repair to improve diplopia, 11 of 17 patients to improve parasthesia, 11 of 15 patients to improve enophthalmos, 8 of 9 patients to improve extraoccular muscle limitation. Duration of follow-up time ranged from 6 months to 12 months(mean, 7.4 months). There was no statistic difference of sequelae between micro titanium mesh and porous polyethylene and absorbable mesh plate in blowout fracture, inferior wall. Conclusion: There is no difference of sequelae between micro-titanium mesh, porous polyethylene and absorbable mesh plate in blow-out fracture, inferior wall. The other factors such as defect size, location, surgeon's technique, may influence the outcome of blow-out fracture repair.

• Imaging Science in Dentistry
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• v.45 no.1
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• pp.7-13
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• 2015

Purpose: We have developed a new method of segmenting the areas of absorbable implants and bone using region-based segmentation of micro-computed tomography (micro-CT) images, which allowed us to quantify volumetric bone-implant contact (VBIC) and volumetric absorption (VA). Materials and Methods: The simple threshold technique generally used in micro-CT analysis cannot be used to segment the areas of absorbable implants and bone. Instead, a region-based segmentation method, a region-labeling method, and subsequent morphological operations were successively applied to micro-CT images. The three-dimensional VBIC and VA of the absorbable implant were then calculated over the entire volume of the implant. Two-dimensional (2D) bone-implant contact (BIC) and bone area (BA) were also measured based on the conventional histomorphometric method. Results: VA and VBIC increased significantly with as the healing period increased (p<0.05). VBIC values were significantly correlated with VA values (p<0.05) and with 2D BIC values (p<0.05). Conclusion: It is possible to quantify VBIC and VA for absorbable implants using micro-CT analysis using a region-based segmentation method.

• Archives of Craniofacial Surgery
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• v.16 no.3
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• pp.125-130
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• 2015

Background: Poly-L-lactide materials combined with hydroxyapatite (u-HA /PLLA) have been developed to overcome the drawbacks of absorbable materials, such as radiolucency and comparably less implant strength. This study was designed to evaluate the usefulness of u-HA/PLLA material in the repair of orbital medial wall defects. Methods: This study included 10 patients with pure medial wall blow-out fractures. The plain radiographs were taken preoperatively, immediately after, and 2 months after surgery. The computed tomography scans were performed preoperatively and 2 months after surgery. Patients were evaluated for ease of manipulation, implant immobility, rigidity and complications with radiologic studies. Results: None of the patients had postoperative complications, such as infection or enophthalmos. The u-HA/PLLA implants had adequate rigidity, durability, and stable position on follow-up radiographic studies. On average, implants were thawed 3.4 times and required 14 minutes of handling time. Conclusion: The u-HA/PLLA implants are safe and reliable for reconstruction of orbital medial wall in terms of rigidity, immobility, radiopacity, and cost-effectiveness. These thin yet rigid implants can be useful where wide periosteal dissection is difficult due to defect location or size. Since the u-HA/PLLA material is difficult to manipulate, these implants are not suitable for use in complex 3-dimensional defects.

• Archives of Plastic Surgery
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• v.41 no.4
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• pp.355-361
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• 2014

Background A blow-out fracture is one of the most common facial injuries in midface trauma. Orbital wall reconstruction is extremely important because it can cause various functional and aesthetic sequelae. Although many materials are available, there are no uniformly accepted guidelines regarding material selection for orbital wall reconstruction. Methods From January 2007 to August 2012, a total of 78 patients with blow-out fractures were analyzed. 36 patients received absorbable mesh plates, and 42 patients received titanium-dynamic mesh plates. Both groups were retrospectively evaluated for therapeutic efficacy and safety according to the incidence of three different complications: enophthalmos, extraocular movement impairment, and diplopia. Results For all groups (inferior wall fracture group, medial wall fractrue group, and combined inferomedial wall fracture group), there were improvements in the incidence of each complication regardless of implant types. Moreover, a significant improvement of enophthalmos occurred for both types of implants in group 1 (inferior wall fracture group). However, we found no statistically significant differences of efficacy or complication rate in every groups between both implant types. Conclusions Both types of implants showed good results without significant differences in long-term follow up, even though we expected the higher recurrent enophthalmos rate in patients with absorbable plate. In conclusion, both types seem to be equally effective and safe for orbital wall reconstruction. In particular, both implant types significantly improve the incidence of enophthalmos in cases of inferior orbital wall fractures.

• Archives of Craniofacial Surgery
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• v.20 no.5
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• pp.297-303
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• 2019

Background: Absorbable plates are widely used in open reduction and internal fixation surgeries for facial bone fractures. Absorbable plates are made of polyglycolic acid (PGA), polylactic acid (PLA), polydioxane (PDS), or various combinations of these polymers. The degradation patterns of absorbable plates made from different polymers and clinical courses of patients treated with such plates have not been fully identified. This study aimed to confirm the clinical courses of facial bone fracture patients using absorbable plates and compare the degradation patterns of the plates. Methods: A retrospective chart review was conducted for 47 cases in 46 patients who underwent open reduction and internal fixation surgery using absorbable plates to repair facial bone fractures. All surgeries used either PLA/PGA composite-based or poly-L-lactic acid (PLLA)/hydroxyapatite (HA) composite-based absorbable plates and screws. Clinical courses were confirmed and comparisons were conducted based on direct observation. Results: There were no naturally occurring foreign body reactions. Post-traumatic inflammatory responses occurred in eight patients (nine cases), in which six recovered naturally with conservative treatment. The absorbable plates were removed from two patients. PLA/PGA compositebased absorbable plates degraded into fragments with non-uniform, sharp surfaces whereas PLLA/HA composite-based absorbable plates degraded into a soft powder. Conclusion: PLA/PGA composite-based and PLLA/HA composite-based absorbable plates showed no naturally occurring foreign body reactions and showed different degradation patterns. The absorbable plate used for facial bone fracture surgery needs to be selected in consideration of its degradation patterns.

• Archives of Craniofacial Surgery
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• v.17 no.1
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• pp.1-4
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• 2016

Absorbable plates are used widely for fixation of facial bone fractures. Compared to conventional titanium plating systems, absorbable plates have many favorable traits. They are not palpable after plate absorption, which obviates the need for plate removal. Absorbable plate-related infections are relatively uncommon at less than 5% of patients undergoing fixation of facial bone fractures. The plates are made from a mixture of poly-L-lactic acid and poly-DL-lactic acid or poly-DL-lactic acid and polyglycolic acid, and the ratio of these biodegradable polymers is used to control the longevity of the plates. Degradation rate of absorbable plate is closely related to the chance of infection. Low degradation is associated with increased accumulation of plate debris, which in turn can increase the chance of infection. Predisposing factors for absorbable plate-related infection include the presence of maxillary sinusitis, plate proximity to incision site, and use of tobacco and significant amount of alcohol. Using short screws in fixating maxillary fracture accompanied maxillary sinusitis will increase the rate of infection. Avoiding fixating plates near the incision site will also minimize infection. Close observation until complete absorption of the plate is crucial, especially those who are smokers or heavy alcoholics. The management of plate infection is varied depending on the clinical situation. Severe infections require plate removal. Wound culture and radiologic exam are essential in treatment planning.

• Archives of Plastic Surgery
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• v.38 no.4
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• pp.458-464
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• 2011

Purpose: Metacarpal fractures are common hand injury that may require operative intervention to ensure adequate reduction and stabilization. Traditionally, titanium miniplate was used for rigid fixation of bone fractures. However, the use of permanent plate lends itself to multiple complications such as infection, exposure of the hardware, tendon adhesions, tendon rupture, prolonged pain, bony atrophy and osteoporosis (stress shielding), metal sensitization, and palpation under the skin. This study evaluated the usefulness and stability of biodegradable plates and screws for treatment of metacarpal bone fractures. Methods: There was 17 patients who had surgery for metacarpal bone fracture from April 2007 to June 2010. All patients had open reduction and internal fixation. We used absorbable plates and screws (Inion CPS$^{(R)}$) for internal fixation. Postoperative results were assessed with x-ray. Stability of plates and screws, healing process and its complications were observed by clinical and radiographic assessment. Results: All patients were successfully reduced of bone fracture, and fixations with absorbable plates and screws were stable. The mean follow up period was 7.1 months. 2 patients complained postoperative pain, but they were relieved with analgesics. All patients experienced transient stiffness, but they were relieved with active assistive range of motion after removal of splint. No patients suffered complications which could be occurred by using metallic plate. Conclusion: There was no critical complications such as re-fracture or nonunion among patients. No patients suffered side effects related with metallic implants. Biodegradable implants can offer clinically stable and attractive alternative to metallic implants to stabilize metacarpal bone fractures in the hand.

• Proceedings of the Korean Society of Precision Engineering Conference
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• 2009.06a
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• pp.995-996
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• 2009