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PubMed2004

A comparative study of three different biomaterials in the engineering of skeletal muscle using a rat animal model.

Defects caused by traumatic or postsurgical loss of muscle mass may result in severe impairments of the functionality of skeletal muscle. Tissue engineering represents a possible approach to replace the lost or defective muscle. The aim of this study was to compare the suitability of three different biomaterials as scaffolds for rat myoblasts, using a new animal model. PKH26-fluorescent-stained cultured rat myoblasts were either seeded onto polyglycolic acid meshes or, alternatively, suspended in alginate or in hyaluronic acid-hydrogels. In each of the eight Fisher CDF-344 rats, four capsule pouches were induced by subcutaneous implantation of four silicone sheets. After two weeks the silicone sheets were removed and myoblast-biomaterial-constructs were implanted in the preformed capsules. Specimens were harvested after four weeks and examined histologically by H&E-staining and fluorescence microscopy. All capsules were well-vascularized. Implanted myoblasts fused by forming multinucleated myotubes. This study demonstrates that myoblasts seeded onto different biomaterials can be successfully transplanted into preformed highly vascularized capsule pouches. Our animal model has paved the way for studies of myoblast-biomaterial transplantations into an ectopic non-muscular environment.

Absorbable Implants↗

PubMed2004

Tissue response to the implantation of biodegradable polyhydroxyalkanoate sutures.

Polyhydroxyalkanoate (PHA) sutures were implanted to test animals intramuscularly, and tissue reaction was investigated and compared with the reaction to silk and catgut. Tested monofilament sutures made of PHAs of two types--polyhydroxybutyrate (PHB) and a copolymer of hydroxybutyrate and hydroxyvalerate (PHV)--featured the strength necessary for the healing of muscle-fascial wounds. The reaction of tissues to polymeric implants was similar to their reaction to silk and was less pronounced than the reaction to catgut; it was expressed in a transient post-traumatic inflammation (up to four weeks) and the formation of a fibrous capsule less than 200 microm thick, which became as thin as 40-60 microm after 16 weeks, in the course of reverse development. Macrophages and foreign-body giant cells with a high activity of acid phosphatase were actively involved in this process. PHB and PHB/PHV sutures implanted intramuscularly for an extended period (up to one year) did not cause any acute vascular reaction at the site of implantation or any adverse events, such as suppurative inflammation, necrosis, calcification of the fibrous capsule or malignant tumor formation. No statistically significant differences were revealed in the tissue response to polymer sutures of the two types. Capsules around silk and catgut sutures did not become significantly thinner.

Absorbable Implants↗

PubMed2006

A novel bioerodible deep scleral lamellar cyclosporine implant for uveitis.

PURPOSE: To determine the feasibility, safety, and effectiveness of an episcleral or deep scleral lamellar sustained release cyclosporine (CsA) device in a naturally occurring animal model of uveitis. METHODS: A two-compartment perfusion chamber was used to assess in vitro human and equine scleral permeability of fluorescein, dexamethasone-fluorescein, or CsA. A biodegradable, matrix-reservoir CsA implant was designed, and release rates of CsA were determined in vitro. Tissue CsA levels were measured in eyes with the implant. Horses with equine recurrent uveitis (ERU) received episcleral or deep scleral lamellar CsA implants and were monitored for up to 3 years. RESULTS: Dexamethasone-fluorescein and CsA penetrated the in vitro equine sclera poorly; however, low but detectable levels of CsA were detected intraocularly in vivo. The implant placed episclerally failed to control inflammatory episodes in ERU. CsA implants placed in the deep sclera adjacent to the suprachoroidal space resulted in high levels of CsA in most ocular tissues. In clinical equine patients with ERU, frequency of uveitic flare-ups was significantly decreased after implantation of a deep scleral lamellar CsA implant. CONCLUSIONS: Diffusion of CsA across the sclera from the episcleral space was not a feasible method of drug delivery to the equine eye. However, placing a deep scleral lamellar CsA implant adjacent to the suprachoroidal space was effective in achieving therapeutic ocular drug concentrations and controlling uveitis in horses with ERU.

Absorbable Implants↗

PubMed2004

Osteoblast proliferation behavior and bone formation on and in CO3apatite-collagen sponges with a porous hydroxyapatite frame.

To develop a new biodegradable scaffold biomaterial reinforced with a frame, synthesized CO3apatite (CO3Ap) was mixed with a neutralized collagen gel. Then, 0 and 70% (w/w) CO3Ap-collagen mixtures (70% CO3Ap weight/mixture weight) were lyophilized into sponges in a HAp frame ring with 0.5-mm pores. SEM observation of CO3Ap-collagen sponges showed favorable pores for cells invasion. Mouse osteoblast MC3T3-E1 cells were cultured in alphaMEM with 10% FCS for 1, 10 and 20 days. Matrix substances on the pure collagen sponge samples increased with the culture period such that the sponge surface was almost covered. A sectional view of hematoxylin-eosin staining confirmed that osteoblast cells had well invaded the CO3Ap-collagen sponge. When these sponge-frame complexes were implanted beneath the periosteum cranii of rats, newly created bone was observed to grow toward the inner core of the complex from the surface of the periosteum cranii. Based on these results, reinforced CO3Ap-collagen sponges are expected to be used as hard tissue scaffold biomaterials for therapeutic purposes.

3T3 Cells↗

PubMed2006

Implantation of oxygen enhanced, three-dimensional microporous L-PLA polymers: a reproducible porcine model of chronic total coronary occlusion.

We have hypothesized that oxygen enhanced three-dimensional microporous poly-L-lactic acid (L-PLA) bioabsorbable polymer constructs could be implanted to produce a subacute occlusion in a porcine coronary artery, forming a thrombofibrotic occlusion containing microvascular channels. Chronic total occlusion (CTO) is increasingly prevalent in patients who present for percutaneous interventions. No reproducible animal coronary model simulating human CTOs has previously been developed. Swine coronary arteries were cannulated and a microporous L-PLA polymer pledget was advanced into a preselected segment of coronary. The coronary arteries were angiographically re-imaged at day 3, day 10, and day 28, to document the presence or absence of an occlusion. Histopathology was also performed at each time point to evaluate the lesion characteristics. A novel three-dimensional L-PLA microporous polymer construct, when implanted into porcine coronary arteries, reproducibly results in the development of a CTO at day 3. The histopathology in this porcine coronary model of CTO at day 28 closely mimics human coronary CTO, including the presence of microvascular channels and dense collagen and elastic tissue in the occlusion.

Absorbable Implants↗

PubMed2004

Biomechanical evaluation of a new cross-pin technique for the fixation of different sized bone-patellar tendon-bone grafts.

To overcome the disadvantages of interference-screw fixation of bone-patellar tendon-bone (BPTB) grafts, new fixation techniques for anterior cruciate ligament (ACL) grafts using biodegradable pins have been developed. The hypothesis of the present study was that cross-pin fixation techniques provide a primary stability that is comparable to that of interference screws. A biomechanical in vitro study was discussed. Human BPTB grafts of 8, 9 and 10 mm diameter were fixed in bovine knees with biodegradable cross pins (diameter: 2.0, 2.7 or 3.2 mm) or biodegradable interference screws. Stiffness and ultimate load were evaluated. For 9 and 10 mm BPTB grafts, no statistically significant difference in maximum load and stiffness was found between the four fixation techniques tested. For 8 mm bone blocks the maximum load of the 3.2 mm pins (274.2 N) was significantly lower than for the 2.0 mm pins (479.8 N) and the interference screws (504.0 N). Predominant failure mode in this group was bone-block fracture. Thicker grafts (9 and 10 mm) fixed with the 2.0 mm pins predominantly failed by implant fracture. Femoral fixation of 8, 9 and 10 mm BPTB grafts using cross pins leads to biomechanical properties that are comparable to biodegradable interference screws when tested by a single-cycle load to failure. Cross pins provide a rigid fixation for 9 and 10 mm BPTB grafts.

Absorbable Implants↗

PubMedDate not supplied

Reconstruction of complex orbitocranial deformities using bioresorbable mesh, sterilized orbital models, and in situ contouring.

PURPOSE: To assess the efficacy of bioresorbable mesh in reconstruction of orbitocranial deformities. METHODS: A retrospective case series evaluating 6 orbits of 6 patients, ages 12 to 70 years old, with large multicontoured orbitocranial defects that were repaired using bioresorbable macroporous mesh. Both functional (presence of diplopia, ocular motility, exophthalmometry, and vertical globe position) and cosmetic outcomes were evaluated. RESULTS: Follow-up time ranged from 20 to 48 months (mean, 29.1 months). After surgery, all patients reported cosmetically pleasing results. Diplopia resolved in all patients. Ocular motility, exophthalmos, enophthalmos, and vertical globe positioning improved in all patients. One patient had new onset of mild enophthalmos and hypoglobus after surgery. No cases of implant exposure or instability occurred. Complications included one patient with skin breakdown over a previous site of irradiation and one patient with ptosis requiring surgical correction. CONCLUSIONS: Bioresorbable macroporous mesh combined with bone grafts is a useful and accurate method to reconstruct complex multicontoured orbitocranial defects.

Absorbable Implants↗

PubMed2004

In vivo study of CORAGRAF: a preliminary results.

The main objective of the study was to determine the biodegradability, resorption and osteoconductivity potency of coral implant. Coral blocks (CORAGRAF) were prepared from sea coral Porites species. The blocks were implanted in the right mandible of rabbit model. Implants were harvested at 2 and 4 weeks intervals and subjected for light and scanning electron microscopy. Dense hydroxyapatite (DHA) was implanted in the left mandible as a control. The results of this study demonstrated that CORAGRAF is a good implant material that can accelerates bone healing and be resorbed in an acceptable time. The mechanisms of the resorption seemed to be the same (crumbling process), a first step where the edge of the coral become powdery then a second step which could be phagocytosis and dissolution in extracellular fluid.

Absorbable Implants↗

PubMed1999

Cell culture test of TCP/CPLA composite.

Thermoplastic polymers filled with a ceramic powder (here described as a "composite") of beta-tricalcium phosphate (TCP) and copoly-L-lactide (CPLA) was prepared by a heat-kneading method. The TCP/CPLA composite obtained had a three-point bending strength of 51.26 +/- 634 MPa, a Young's modulus of 5.18 +/- 1.11 GPa, and a fracture strength of 52.64 +/- 2.975 MPa, which is sufficient for usage as an artificial bone implant material. According to cell culture tests using MC3T3-E1 cells, the TCP/CPLA composite showed no cytotoxicity and the cells were in close contact with the surfaces of the composite without any observable morphological change. These results suggest that a composite consisting of osteoconductive TCP and biodegradable CPLA is suitable as a bioactive artificial bone material.

Absorbable Implants↗

PubMed2002

Complications in the first 1,043 operations where self-reinforced poly-L-lactide implants were used solely for tissue fixation in orthopaedics and traumatology.

This is an analysis from one hospital of the first 1043 operations where pure self-reinforced poly-L-lactide (SR-PLLA) implants have been used alone. The operations were performed between 1988 and 1999 and included 407 orthopaedic patients and 636 trauma patients. There was a total of 107 complications. There were 21 infections but no sinus formation. Failure of fixation was seen in 46 patients. In 936 operations the healing was uneventful.

Absorbable Implants↗

PubMed2005

Physiologic properties of small intestine submucosa.

BACKGROUND: Porcine small intestine submucosa (SiS) has been introduced as a bioprosthesis in herniorrhaphy. This study evaluates in vivo properties of SiS that would affect clinical use. MATERIALS AND METHODS: Twelve pigs underwent implantation of SiS (perforated and nonperforated) on the peritoneal surface. Gross characteristics were evaluated and random samples harvested for histological study at 2 (n = 6) and 8 (n = 6) weeks. Collagen deposition was determined by polarized microscopy. Neovascularity (percent area blood vessels, %A(bv)) was determined by immunohistochemical staining with a polyclonal CD-31 antibody. RESULTS: Perforated SiS had a higher density of capillary ingrowth compared with nonperforated at both 2 (5.6%A(bv) versus 1.4%A(bv), P < 0.05) and 8 weeks (6.0%A(bv) versus 1.6%A(bv), P < 0.05). Compared with 2 weeks, 8-week SiS had a larger proportion of incorporation (25% versus 83%, P < 0.05) and new collagen deposition (50% versus 94%, P < 0.05). Significant contraction was observed in SiS 8 weeks after implantation (preimplant area 98 cm2 versus post-implant area 50 cm2, P < 0.05). CONCLUSION: SiS incorporated well 8 weeks after implantation, with deposition of new collagen. Perforated SiS demonstrated a more rapid and greater amount of neovascularity. The degree of contraction suggests that larger areas of SiS should be selected for herniorrhaphy than would be necessary if synthetic materials were used.

Absorbable Implants↗

PubMed2004

The influence of a biomaterial on the closure of a marginal hard tissue defect adjacent to implants. An experimental study in the dog.

OBJECTIVES: The present experiment was performed to determine the influence of Bio-Oss on hard tissue formation at sites that, following implant installation, presented a 1-1.25 mm wide marginal defect. MATERIAL AND METHODS: Four Labrador dogs were used. The premolars and first molars on both sides of the mandible were extracted. After 3 months, mucoperiosteal flaps were elevated and three experimental sites were prepared for implant installation in each side of the mandible. A step drill was used to widen the marginal 5 mm of the canal. Thus, following the placement of the implant (3.3 x 10 mm, SLA surface, Straumann AG, Waldenburg, Switzerland) a circumferential gap, about 1-1.25 wide and 5 mm deep, remained lateral to the titanium rod. The test sites in the left side of the mandible were first filled with a deproteinized cancellous bone mineral (Bio-Oss). The defect sites in the right side of the mandible (control sites) were left for spontaneous healing. A resorbable barrier membrane (Bio-Gide) was placed to cover the implant and the bone tissue in two sites of each quadrant, while the third site was left without membrane placement. The flaps were repositioned to cover all defect sites and were sutured. After 4 months of healing, block biopsies of each implant site were dissected and processed for ground sectioning. RESULTS: It was demonstrated that at 4 months, all types of defects were filled with newly formed bone and that the biomaterial placed in the marginal defect in conjunction with implant installation during healing became incorporated in the newly formed bone tissue. A high degree of contact was established between the Bio-Oss particles and the newly formed bone. CONCLUSION: Bio-Oss became integrated with the newly formed bone. In the model used, Bio-Oss did not enhance the process of bone formation and defect closure.

Absorbable Implants↗

PubMed2002

Endoscopic implantation of a biopolymer in the lower esophageal sphincter for gastroesophageal reflux: a pilot study.

BACKGROUND: GERD is the most frequent disorder of the esophagus. Endoscopic minimally invasive treatment is desirable. However, the results of injection techniques have been disappointing. METHODS: A pilot study was conducted in patients with GERD, who required continuous therapy with a proton pump inhibitor, in which ethylene-vinyl-alcohol was injected into the muscle of the gastric cardia. Primary endpoints were the safety of the procedure, the effect on lower esophageal sphincter pressure and the stability of the injected material. A secondary endpoint was the effect on heartburn score after discontinuation of treatment with a proton pump inhibitor. RESULTS: Ethylene-vinyl-alcohol injection into the cardia resulted in circular diffusion of the product in 10 of 15 cases, suggesting that implantation into the muscle is feasible. Lower esophageal sphincter pressure was increased in 13 of 15 cases at 1 month and was sustained at a median follow-up of 6 months (range 4-12 months). Mean plus minus SEM of lower esophageal sphincter pressures (15 patients) were 12.2 plus minus 0.9, 18.7 plus minus 1.5 (p = 0.001 at baseline), and 16.7 plus minus 1.3 mm Hg (p = 0.038 from baseline) at, respectively, baseline, 1 month follow-up, and final follow-up. There was also a sustained reduction in heartburn score (off proton pump inhibitor) (3.40 plus minus 0.13 vs. 1.53 plus minus 0.24 and 1.87 plus minus 0.26 at baseline vs. 1 month and final follow-up, respectively; p < 0.01). Nine of the 15 patients had more than 50% of the injected material in place at second follow-up (at 6 months for 8 patients; at 12 months for 1 patient). In only 2 patients was there loss of more than 75% of injected ethylene-vinyl-alcohol. Persistence of greater than 50% of the material was associated with achievement of a circular injection. Only 4 patients had to resume therapy with a proton pump inhibitor. Mild retrosternal discomfort was observed in 8 patients; this disappeared in all cases after a maximum of 3 days. CONCLUSIONS: Ethylene-vinyl-alcohol implantation in the muscle of the cardia is feasible and safe. It leads to a sustained increase in resting lower esophageal sphincter pressure. This is associated with a sustained improvement in heartburn score for patients who previously required continuous therapy with a proton pump inhibitor.

Absorbable Implants↗

PubMed2004

Resorbable PLLA-PGA plate and screw fixation in pediatric craniofacial surgery: clinical experience in 1883 patients.

The need to provide rigid bony fixation in the surgical treatment of craniofacial deformities has inspired an on-going evolution of surgical innovations and implants. Because of the young age of many treated craniosynostosis patients and the unique pattern of cranial vault growth, the extensive implantation of metal devices is potentially problematic. The use of resorbable plate and screw devices offers all of the benefits of rigid fixation without many of their potential risks. Since the introduction of resorbable plate and screw devices in 1996, tens of thousands of craniofacial patients have received implants, but long-term results from a large series have yet to be reported. A combined prospective and retrospective analysis was done on 1883 craniosynostosis patients under 2 years of age treated by 12 surgeons from seven different geographic locations over a 5-year period who used the same type of resorbable bone fixation devices (poly-L-lacticpolyglycolic copolymer). Specifically, the incidence of postoperative infection, fixation device failure, occurrence of delayed foreign-body reactions, and the need for reoperation resulting from device-related problems were determined. Technical difficulties and trends in device use were also noted. From this series, significant infectious complications occurred in 0.2 percent, device instability primarily resulting from postoperative trauma occurred in 0.3 percent, and self-limiting local foreign-body reactions occurred in 0.7 percent of the treated patients. The overall reoperation rate attributable to identifiable device-related problems was 0.3 percent. Improved bony stability was gained by using the longest plate geometries/configurations possible and bone grafting any significant gaps across plated areas that were structurally important. The specific types of plates and screws used evolved over the study period from simple plates, meshes, and threaded screws to application-specific plates and threadless push screws whose use varied among the involved surgeons. This report documents the safety and long-term value of the use of resorbable (LactoSorb) plate and screw fixation in pediatric craniofacial surgery in the infant and young child. Device-related complications requiring reoperation occurred in less than 0.5 percent of the implanted patients, which is less frequent than is reported for metallic bone fixation. Resorbable bone fixation for the rapidly growing cranial vault has fewer potential complications than the traditional use of metal plates, screws, and wires.

Absorbable Implants↗

PubMed2004

Macroporous biodegradable natural/synthetic hybrid scaffolds as small intestine submucosa impregnated poly(D,L-lactide-co-glycolide) for tissue-engineered bone.

Poly(D,L-lactide-co-glycolide) (PLGA), a biodegradable synthetic polymer, is widely used in a variety of tissue-engineered applications, including drug-delivery systems. However, the PLGA scaffolds, macroporous and three-dimensional structure, are difficult to cell attachment and in-growth due to surface hydrophobicity. In order to introduce in new bioactive functionality from porcine small intestine submucosa (SIS) as natural source for PLGA, we fabricated SIS-powder-impregnated PLGA (SIS/PLGA) hybrid scaffolds. Fabrication parameters, including ratios of SIS, PLGA and salt, were optimized to produce the desired macroporous foam. The scaffolds had a relatively homogeneous pore structure, good interconnected pores from the surface to core region and showed an average pore size in the range 69.23-105.82 microm and over 90% porosity. The SIS/PLGA scaffolds degraded with a rate depending on the contents of the SIS. After the fabrication of the SIS/PLGA hybrid scaffolds the wettability of the scaffold was greatly enhanced, resulting in uniform cell seeding and distribution. So, it was observed that BMSC attachment to the SIS/PLGA scaffolds increased gradually with increasing SIS contents. Scaffolds of PLGA alone and SIS/PLGA were implanted subcutaneously under dorsal skin of athymic nude mouse to observe the osteoconductivity. It was found from the result that the effects of the SIS/PLGA scaffolds on bone formation are stronger than control PLGA scaffolds. In summary, the SIS/PLGA scaffolds have osteoconductive effects to allow remodeling and replacement by osseous tissue.

Absorbable Implants↗

PubMed2006

Five-year experience comparing resorbable to titanium miniplate osteosynthesis in cleft lip and palate orthognathic surgery.

OBJECTIVE: To evaluate 5-year outcome stability and complications in orthognathic surgery using resorbable versus titanium osteofixation. PATIENTS, METHODS: Twenty-two cleft lip and palate maxillary retrognathia cases were operated on using either poly (70L-lactide-co-30DL-lactide) or titanium miniplate osteofixation. All had two-piece Le Fort I maxillary advancement osteotomy, 11 had simultaneous mandibular setback, and 13 had alveolar bone grafts. RESULTS: Average operative movement and postoperative instability recorded for maxillary horizontal movement (A-point-Nasion) were 2.5 mm and 2.1 mm for the study group, compared with 6.3 mm and 1.9 mm for the control group. For maxillary vertical movement (ANS-Nasion), measured values were 4.9 and 1.3 mm for the study group and 2.3 and 0.9 mm for the controls. For mandibular horizontal movement, measured values were 10.7 mm and 2.8 mm for the study group and 1.9 mm and 0.8 mm for the controls. Gonial angle measures were 7.1 degrees and 3.5 degrees for the study group and 6.7 degrees and 3.1 degrees for the controls. Foreign body granuloma and fistulation occurred in 1 (9%) member of the study group, but was treated successfully with debridement; implant palpability subsided after 24 months. Three (27%) controls required plate removal, but the remaining plates were palpable. CONCLUSION: In the study group, horizontal maxillary stability appeared inferior to vertical stability, but mandibular stability was more reliable. Because groups were not matched for magnitude or direction of movement, the results of this study are preliminary and should be interpreted cautiously.

Absorbable Implants↗

PubMed2006

Influence of stocking rate and steroidal implants on growth rate of steers grazing toxic tall fescue and subsequent physiological responses.

An 84-d grazing experiment was conducted in 2 growing seasons to evaluate interactions of stocking rate and steroidal implants with BW gain and symptoms of toxicosis in yearling steers grazing endemic endophyte-infected (E+) tall fescue (Festuca arundinacea Schreb.). A 4 x 2 factoral design was used to evaluate 4 stocking rates (3.0, 4.0, 5.0, and 6.0 steers/ ha) with or without steroidal implants (200 mg of progesterone + 20 mg of estradiol benzoate). Treatment combinations were randomly assigned to eight 1-ha pastures of E+ Kentucky-31 tall fescue (i.e., treatments were not replicated). Treatment effects were analyzed for ADG, total BW gain per hectare, forage availability, and hair coat ratings. At the conclusion of grazing in the second year (22 June), steers were placed on a bermudagrass [Cynodon dactylon (L.) Pers.] pasture, and rectal temperatures and serum prolactin concentrations were monitored for 10 d to assess carryover effects of stocking rate and steroidal implants on recovery from toxicosis-related heat stress. Forage availability differed (P < 0.001) between years, but there were no year x treatment interactions (P > 0.10). There was an implant x stocking rate interaction (P < 0.05) on ADG. Differences between the slopes in the regression equations indicated that ADG responded to implantation when stocking rates were low, but the response diminished as stocking rate increased. Stocking rate did not influence (P = 0.89) postgraze rectal temperature, but the regression intercept for implanted steers was 0.4 degrees C greater (P < 0.05) than for nonimplanted steers, and the difference was consistent across the entire 10-d fescue-free grazing period. Concentrations of prolactin increased during the 10-d fescue-free grazing period, but trends differed due to an implantation x stocking rate interaction (P < 0.05). Results indicate that implantation with progesterone + estradiol benzoate increases ADG with lower stocking rates, but the effect diminishes with increased grazing intensity. Implantation with steroid hormones increased rectal temperatures, but during a fescue-free grazing period rectal temperatures and serum prolactins for implanted and nonimplanted steers returned to values indicative of a stable and healthy status in a 192- to 240-h (i.e., an 8- to 10-d) period. However, because the treatments used in this study were not replicated, these observations need to be confirmed with replicated studies.

Absorbable Implants↗

PubMedDate not supplied

Ridge augmentation with dense hydroxylapatite/resorbable suture matrix.

The atrophic edentulous ridge represents one of the greatest challenges faced in general practice. An estimated 20 million adults in the U.S. are edentulous in at least one arch and a significant number of these patients experience problems with their prostheses from alveolar bone loss. Many of these patients, for various reasons, are not candidates for endosseous dental implants. Alveolar ridge augmentation is a viable option in many of these cases; however, this procedure has been unpredictable because of particle migration. Presented here is a method of ridge augmentation with dense hydroxylapatite beads linked in a resorbable suture matrix to prevent particle migration during healing. This technique may be performed with minimally invasive surgery, providing long-term prosthetic support.

Absorbable Implants↗