New Resorbable Plate and Screw System in Pediatric Craniofacial Surgery

Abstract

Early forms of resorbable fixation induced foreign body reactions requiring surgical removal of the fixation material. Most current plating systems attempt to circumvent this phenomenon by altering the composition of the α esters involved. ResorbX (KLS Martin, Jacksonville, FL), a plating system derived from 50:50 poly(D,L)lactide, boasts short resorption times, minimal foreign body reaction, and adequate strength for bony fixation. We present our experience with 134 patients undergoing correction of primary craniosynostosis, using ResorbX. One hundred thirty-four consecutive craniosynostosis patients underwent correction with calvarial remodeling by the senior author between April 2002 and March 2008. Five patients had 2-stage repairs. Postoperative analysis included plate visibility or palpability, head contour, and the incidence of complications. The mean age at repair was 17.0 months, with the median age being 9.0 months (range, 2.5-137 months). Postoperative follow-up visits were recorded at 3-month intervals from 0 to 24 months. Synostosis diagnoses were as follows: 43 metopic, 37 sagittal, 27 coronal, 5 lambdoid, and 27 multisutural synostosis. There were 3 complications requiring operative intervention. Three plates became exposed through the coronal excision, requiring removal, for an overall complication rate of 2%. Forty-four patients (31.7%) had a visible mass at the site of fixation at some point postoperatively; all of these resolved through observation only. Overall postoperative head aesthetics were deemed satisfactory to excellent, and no instances of contour regression occurred. This study documents the safety and efficacy of ResorbX in pediatric cranial vault remodeling. The system is easy to use, and with the advent of an ultrasonic pin, more abbreviated operating and anesthesia times are achievable.

Absorbable sutures for the achievement of stable osteosynthesis in surgery for craniosynostosis

“…The absence of these findings confirms the results of a recent clinical study of 129 patients described by Linz et al where stable osteosynthesis was achieved absolutely with the use of Vicryl (Ethicon, Germany) suture material. This is in contrast to numerous studies in the literature which describe similar adverse reactions from the use of absorbable plates and screws [20]. According to another clinical study performed by Sanger et al, the complication rates from the use of Vicryl sutures for osteosynthesis were under 1% [21].…”

Evaluation of Resorbable Plates With Ultrasonic Welded Pins in the Management of Midface Fractures (Clinical, Histological, and Biomechanical Study)

“…Most common raw materials for the fabrication of biodegradable materials are polymers and copolymers of glycolicacid (polyglycolid, PGA), lactic acid (polylactid, PLA), and mixtures of D-and L-lactides (PDLLA) The biodegradation of resorbable osteosynthesis depends on 2 main factors: the composition of the material itself and the surrounding tissue. The manufactured combination determines the properties as biomechanical stability and biochemical decomposition of the osteosynthesis plates (6).…”

Comparison of Resorbable Plating Systems

“…Wood et al reported on the use of ResorbX to treat 134 consecutive cases of primary craniosynostosis (20). The authors followed patients for an average of 18 months, which they suggest is the interval for complete resorption in pediatric patients.…”