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At least 73 records · Page 4Linked to original sources

Skin replacement with Bioplast fibrin in Ophthalmology.

The study includes 40 cases of skin replacement performed by an ophthalmologist over a period of 4 years. An absorbable implant material, Bioplast fibrin, was used as a graft following the extirpation of 12 eyelid tumors, the treatment of eight fresh, destructive skin injuries, and the removal of deforming scars around the eyes, in 20 cases. The biocompatible implant provided barrier properties preventing infection or excessive fluid loss. The resorption rate was adjusted to 3-4 weeks. These grafts were gradually replaced by new epithelial tissue growing in from the periphery of the wound edge. The new tissue had the elasticity and cosmetic appearance of surrounding skin. Thus, small periorbital skin tumors can now be removed without the necessity of doing a split thickness skin graft to cover the defect.

Adolescent↗

Difficulty in removal of certain intramedullary nails.

Intramedullary nailing is the most common treatment for displaced diaphyseal fractures of the femur and tibia. Gerhard Küntscher introduced the technique of intramedullary nailing to clinical practice in the 1940s, and this method has been the focus of many authors with regard to indications, technique, complications, and outcome. The five cases presented here represent a complication not often reported in recent years: the difficulty in removing an intact intramedullary nail. Inspection of the interlocking nails in four of the cases presented reveals a specific design characteristic: the cross sectional design of the nail prevents the distal, unslotted end of the nail from being extracted from the medullary cavity. This problem is preventable by a change in nail design or the development of absorbable implants.

Adolescent↗

New absorbable synthetic explants for the treatment of retinal detachment.

The synthetic absorbable materials polyglicolic acid, (PGA) polyglactin (PG910), and polydioxanone (PDS) were used in various combinations in the repair of 82 eyes with retinal detachments. The latter two substances were tested in rabbit eyes and compared with fascia lata, catgut, and silicodesiccated sclera. The absorbable implants were well tolerated in all eyes. The PDS lasted the longest and produced a significant buckling effect for at least 6 months.

Animals↗

Osteolytic changes after polyglycolide pin fixation in chevron osteotomy.

Absorbable polyglycolide pins were used for fixation of 94 chevron osteotomies in 70 patients at the Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, between 1986 and 1992. Postoperative osteolytic changes around the degrading pin occurred in 21 of 94 (22%) metatarsal heads. In 17 of 21 metatarsal heads, polydioxanone-coated polyglycolide pins were used. This type of pin has not been used since 1988. At follow-up, 16 of 21 osteolytic changes resolved completely and four partially resolved. In the remaining one, the osteolytic area remained visible after 6 years. Cystic changes in the metatarsal head, not attributable to the location of the absorbable implants, occurred in seven (7.4%) metatarsal heads and avascular necrosis of the entire metatarsal head in one (1.1%). Foreign body reaction occurred in six (6.3%) metatarsal heads and wound infection in three (3.2%) metatarsal heads. No association was observed between osteolytic changes and foreign body reaction or infection. Osteolysis in patients receiving polyglycolide implants only require observation, because associated symptoms with the radiographic findings are transient.

Adolescent↗

Polymeric debris from absorbable polyglycolide screws and pins. Intraosseous migration studied in rabbits.

The migration of polymeric particles during degradation of absorbable implants made of polyglycolide was investigated in the cancellous bone of distal rabbit femur by using a transverse osteotomy model. The osteotomy was fixed either with a 4.5 x 25 mm screw or with two 1.5 x 30 mm pins. The histologic sections obtained at 3, 6, 12, and 36 weeks were morphometrically analyzed using polarized-light microscopy. The migration of the polymeric debris into the host-tissues showed two different patterns. On the one hand, particles were in all specimens seen lying intracellularly in phagocytic cells in a regular front close to the original tissue-implant boundary. In addition, in several specimens there occurred expansions filled with largely extracellular polymeric particles that bulged into the hematopoietic bone marrow up to 2.8 mm from the original implant cavity. This kind of particle migration over long distances could not be explained by cellular transport, but may have been caused by an increased osmotic pressure that developed within the implant cavity during depolymerization of polyglycolide.

Animals↗

Ankle fractures treated using biodegradable internal fixation.

In order to reduce the resources needed for the removal of metallic fixation devices in fracture treatment, absorbable implants of biodegradable synthetic polymers were developed using self-reinforced lactide-glycolide copolymer and polyglycolide. In a prospective study 102 patients with displaced unimalleolar or bimalleolar fractures of the ankle were managed using internal fixation devices consisting of cylindrical biodegradable implants 3.2 or 4.5 mm in diameter and 50 or 70 mm in length. After open reduction of the fracture a channel was drilled from the tip of the malleolus into the cancellous bone through the fracture surfaces. A biodegradable rod of the same diameter was then tapped into the drill channel to fix the fracture. Postoperatively, the ankle was immobilized by a plaster cast for six weeks. An anatomic initial reduction was achieved in 93 patients (91%). A slight secondary displacement occurred in four patients. In six patients a sinus formation yielding remnants of the degrading implant was seen two to four months after the operation. This minor complication did not influence the union of the fracture or functional recovery. At the one-year follow-up examination there was no change in the ability to participate in sports and other physical activities in 89 patients (87%). The biodegradable fixation method is now the routine approach of the department in treating displaced unimalleolar and bimalleolar ankle fractures. New clinical applications for the implants are under trial.

Adolescent↗

Gelatin film. A useful adjunct in rhinoplastic surgery.

Gelfilm is a nonporous, rigid, cellophane-like absorbable gelatin. Its use in preventing adhesions in neurosurgery and ophthalmic, otologic, and chest surgery has been well described. It has not been previously reported for nasal surgery. It incorporates many characteristics of an ideal absorbable implant. The material has been used clinically as a dorsal nasal implant either alone or as a vehicle for autogenous cartilage grafts. Its main function is to diminish adhesions between the nasal bones and dorsal skin after surgery on the nasal pyramid. Its benefits seem most applicable in traumatic or revisionary rhinoplasty. Its use has been well documented in 40 cases with a one-year follow-up. The only disadvantage is a slight prolonged dorsal edema until the implant resorbs. The results have been impressive in both early and late postoperative follow-up because the nasal dorsum appears smoother and the skin nonadherent.

Animals↗

Absorbable polyglycolide pins in internal fixation of fractures in children.

Absorbable implants made of synthetic biodegradable polymers were recently introduced clinically in internal fixation of fractures. In this prospective study of 71 pediatric patients with a variety of displaced physeal or nonphyseal fractures, self-reinforced polyglycolide pins 1.5 or 2.0 mm in diameter were used instead of Kirschner wires to fix the fragments. The majority of patients (45 children) had a fracture affecting the distal humerus. Mean age of the patients was 9.8 years (range 2-15 years). Follow-up averaged 15.8 months. In 62 patients (87%), an exact reduction of the fracture could be maintained until union. Among the remaining patients, six had minor inaccuracies or redisplacements of the fracture position, but in three patients with supracondylar fractures of the humerus breakage of the pins resulted in a severe redisplacement that necessitated a change in treatment method. With the exception of supracondylar fractures of the humerus, these preliminary results of polyglycolide pin fixation were deemed satisfactory. The fundamental advantage of this method is that no hardware removal procedures are required.

Adolescent↗

A prospective controlled trial of the fracture of the humeral medial epicondyle--how to treat?

Twenty-one patients, 11 male and nine female, with fracture of medial humeral epicondyle were treated. The mean age of the patients was 21 (range 8-52) years. The average initial displacement was 13 (range 3-24) mm, and four out of 21 patients had a dislocation of the elbow joint. Two patients were first treated conservatively, but later on operation for removal of the non-united fragment and reattachment of the ligaments and muscles was necessary. One patient was treated by primary excision of the fragment. Eighteen patients were treated by open reduction and internal fixation using self-reinforced polyglyclycolide (SR-PGA) screws in five patients, poly-l-lactide (SR-PLLA) screw in one, small (SR-PGA) rods in seven and Kirschner-wires in five patients. Solid union took place in 14 out of 18 patients and a good stability of the elbow joint was achieved. Fifteen patients scored an excellent result according to the scale of Broberg and Morrey. Although this series was not randomly allocated in respect of the method of treatment, it shows that medial epicondylar fractures can be fixed with absorbable implants without any need for removal procedure.

Adolescent↗

Absorbable pins in the treatment of hand fractures.

Open reduction and internal fixation with absorbable devices was used to treat 32 fractures of the hand at our department. The clinical results were reviewed in 20 patients with an average follow-up of 4.5 years. There were 17 metacarpal fractures, 12 phalangeal and three carpal fractures. Thirty fractures were intra-articular. Subjectively 15 of the 20 patients indicated their satisfaction with the outcome of the treatment. Redisplacement of fixation occurred in two Bennett's fractures. A minor redisplacement was observed in one comminuted and in one noncomminuted phalangeal intra-articular fracture. A foreign-body reaction occurred in two patients with a Bennett's fracture and in one with a trapezoid fracture. A wound infection occurred in one patient with a Bennett's fracture and in one patient with a phalangeal fracture. The use of absorbable implants showed promising results in the intra-articular fractures of metacarpal and phalangeal bones with the exception of the Bennett's fractures, where the outcome was less favourable. The number of patients in the study was limited and for a more definitive conclusion a larger series of fractures of the hand should be analysed.

Adolescent↗

Guided bone regeneration for implant placement using absorbable collagen membranes: case presentations.

The current research on the application of guided tissue regeneration principles is focused on the use of absorbable matrix barriers in bone augmentation procedures in extraction sites and around implants. This paper presents two cases in which a new absorbable collagen membrane is used for guided bone regeneration. In the first case, freeze-dried demineralized bone was used with the membrane to place an implant in a fresh extraction site with a grave osseous defect. In the second case, the collagen membrane provided the augmentation of a narrow ridge where three implants were placed, without the use of allograft. In both cases, the barrier membrane demonstrated its applicability for bone regeneration with only one surgical procedure, without complications. The learning objective of this article is to update the knowledge of absorbable barrier membranes from the clinical experience of the authors.

Adult↗

Gelatin implants in scleral buckling procedures.

In 375 scleral buckling procedures, an absorbable gelatin implant (Retina Gelfilm) was used. This series included 192 trapdoor and scleral pouch procedures, and 183 operations in which a gelatin implant was used beneath a silicone rubber implant. Two thicknesses of gelatin implants were used, 0.5 mm and 0.75 mm. Absorption time varied from 2 to 24 months, depending on the thickness of the implant and whether it was used alone or beneath a silicone rubber implant. Gelatin is an excellent absorbable implant when used alone or under a silicone rubber implant in selected patients with retinal detachment to produce a temporary elevation or posterior extension of the buckle, or both.

Gelatin↗

Radiation absorbed from dental implant radiography: a comparison of linear tomography, CT scan, and panoramic and intra-oral techniques.

Absorbed radiation dose in bone marrow, thyroid, salivary gland, eye, and skin entrance was determined by placement of lithium fluoride thermoluminescent dosimeters (TLD's) at selected anatomical sites within and on a human-like x-ray phantom. The phantom was exposed to radiation from linear tomographic and computer-assisted tomographic (CT) simulated dental implant radiographic examinations. The mean dose was determined for each anatomical site. Resulting dose measurements from linear tomography and computer-assisted tomography are compared with reported panoramic and intra-oral doses. CT examination delivered the greatest dose, while linear tomography was generally lowest. Panoramic and intra-oral doses were similar to those of linear tomography.

Dental Implantation, Endosseous↗

Regeneration of pericardial tissue on absorbable polymer patches implanted into the pericardial sac. An immunohistochemical, ultrastructural and biochemical study in the sheep.

A new absorbable polymer prepared from polyhydroxybutyrate (PHB) was inserted as a pericardial patch in sheep to serve as a temporary scaffold for regeneration of pericardial tissue. Postoperative adhesions were rare or absent. The present study focuses on characterization of the regenerated surface cells. The luminal surface of the regenerated tissue was covered with a complete layer of mesothelium-like cells which at light and scanning electron microscopy resembled those in native pericardium. Immunohistochemical stainings for cytokeratin and thrombomodulin were positive in these cells. Heparan sulfate proteoglycan was found in a basement-membrane-like structure beneath the surface cells, as in the normal pericardium. Transmission electron microscopy of the regenerated surface revealed cells with the characteristics of mesothelium. Prostacyclin production in the regenerated tissue was similar to that in native pericardium. The results indicate regeneration of a mesothelial layer with many of the important functions of native mesothelial cells. This may explain the presently and previously observed prevention of pericardial adhesions after cardiac surgery in this field. Clinical testing of PHB patches as pericardial substitutes is warranted in cardiac surgery when pericardial closure is desired.

Animals↗

Osteolytic changes accompanying degradation of absorbable fracture fixation implants.

We analysed the radiographs of 67 patients with displaced malleolar fractures treated by open reduction and internal fixation using absorbable polyglycolide rods. Seventeen patients developed a discharging inflammatory foreign-body reaction, a complication unique to these fixation devices. In 34 patients ovoid osteolytic foci, usually 5 to 10 mm in diameter, appeared within the implant channels six to 12 weeks after the operation. The same lesion occurred in 14 of the 17 patients who developed a foreign-body reaction, whereas only 20 out of the 50 patients with an uneventful course showed osteolytic areas (p less than 0.01). In patients with a foreign-body reaction the osteolytic foci tended to occur in the deepest parts of the implant channels. However, after one year the normal structure of the bone was restored.

Adult↗

Stress-absorbing elements in dental implants.

By means of finite element analysis, calculations, were made of the stress-distribution in bone around implants with and without stress-absorbing elements. A freestanding implant and an implant, it was concluded the variation in the E-modulus of the stress-absorbing element had no effect on the stresses in bone. Changing the shape of the stress-absorbing element had little effect on the stresses in cortical bone. For the implant connected with a natural tooth, it was concluded that a more uniform stress was obtained around the implant with a low E-modulus of the stress-absorbing element. It was also concluded that the bone surrounding the natural tooth showed a decrease in the height of the peak stresses.

Computer Simulation↗

Clinical experiences with a new maintenance-free shock absorbing element in titanium implants.

Until now, the biokinetic elements of one implant system were to be substituted once a year in order to prevent complications of fractures of fixation screws. In this article a new implant with a maintenance-free shock absorbing element was examined. During the last 6 years, 384 dental implants with a biokinetic element (mobile-implant, SIS Inc., Klagenfurt, Austria) were placed in 138 patients. The implants were loaded with prosthetic superstructures 4 months after implantation. For comparison, 160 patients were treated with 494 conventional titanium implants of the same design without biokinetic elements. All patients were examined radiologically and clinically. Periimplant probing depth, periimplant bleeding, Periotest-values (Siemens, Bensheim, Germany) at the time of prosthetic treatment and 3, 6, 9, 12, and 24 months after implant loading were registered. Implantation was successful in 97.2% of mobile-implants and 98% of conventional implants. There was a low degree of sulcus bleeding and high degree of physiological periimplant probing depths in both patients groups. In mobile-implants, the Periotest-values were positive and similar to that of the control. There was no difference between the values in the maxilla and mandible. In the group with conventional implants, the Periotest-values were negative and showed a low degree of negativity during the first 12 months after implant loading. Periotest-values in the upper jaw were higher than in the lower jaw. There was a lower degree of periimplant bone loss after implant loading in patients with mobile-implants. In conclusion, mobile-implants demonstrate the positive effects of implants with shock absorbing elements. They are maintenance free.

Alveolar Bone Loss↗

Bone formation in the goat maxillary sinus induced by absorbable collagen sponge implants impregnated with recombinant human bone morphogenetic protein-2.

This study assessed the efficacy, safety, and technical feasibility of inducing bone formation in an animal model of maxillary sinus floor augmentation using recombinant human bone morphogenetic protein-2 (rhBMP-2) impregnated on an absorbable collagen sponge (ACS). Bilateral antral maxillary sinus floor elevation procedures were surgically performed in six adult female Alpine-Saanen goats. Bone formation in response to the implant was evaluated using sequential radiographs, computerized tomography, and gross pathologic and histologic analysis performed at necropsy. Computerized tomographic scans documented nonosseous radiopacity in both sinuses postimplantation. Sinuses implanted with the rhBMP-2/ACS subsequently demonstrated increasing radiopacity local to the implant site, while radiopacity of the negative control sinuses remained unchanged or decreased. The results demonstrated the ability of an rhBMP-2/ACS implant to induce substantive new bone formation within the maxillary sinus of goats without adverse sequelae. The rhBMP-2/ACS composite implant may represent an acceptable alternative to traditional bone grafts and bone substitutes for maxillary sinus floor augmentation procedures in humans.

Animals↗