Resorbable Fixation Systems Research Articles

The Use of Resorbable Fixation for Posterior Cranial Vault Distraction Osteogenesis

Summary: Posterior vault distraction osteogenesis (PVDO) traditionally relies on the use of cranial distractors affixed with titanium screws to the posterior cranial vault transport segment to allow for expansion of intracranial volume. We describe a novel technique using the Synthes RAPIDSORB IPS resorbable fixation system for stable fixation of the distraction hardware for PVDO. In a retrospective review of our experience with the IPS system, there was no instance of hardware or fixation failure. This off-label use of the IPS system results in a significant reduction in operative time for hardware removal while allowing for a more limited dissection, which can help reduce devascularization of the bony regenerate, bony relapse, and other complications.

Management of mandibular fracture and lacerated wound due to machete trauma in children: case report

Introduction: The facial fractures in pediatric patients are rare, and they need an immediate treatment to recover the function and aesthetic to the young patients. Anatomic reduction along with rigid skeletal stabilization is mandatory until bone union has occurred. Special consideration about variation in anatomy and physiology of pediatric patients, as well as the particular stage of growth and dental development should be preferred. Case report: We present a case of 5 year old girl patient with fractures of the parasymphyseal and left angle of mandible horizontally and vertically unfavourable, with significant displacement and huge lacerated wound of the face caused by machete slashed. We successfully managed the pediatric complex mandible fractures by performing open reduction internal fixation using resorbable miniplates and gunning splint as intermaxillary fixation. Conclusion: Pediatric mandible fractures requiring ORIF are rare. The combination of intermaxillary fixation and resorbable fixation system is needed postoperatively because of the extensive fractures for adequate fixation and good outcomes.

Robust bioactive protein-based screws with dual crosslinked network for internal bone fixation

Resorbable fixation systems have gained interest in orthopedics by avoiding secondary surgery and stress shielding, but lack of enough bioactivity. Herein, we fabricated resorbable and bioactive regenerated silk fibroin/gelatin (RSF/G) screws with dual physically and chemically crosslinked networks, which can control the release of Arg-Gly-Asp (RGD) peptide and bear pull-out and shear forces comparable to those of pure RSF and commercial poly (lactic-co-glycolic acid) devices under dry and wet conditions. The controllable swelling properties of the RSF/G screws support implantation although with the high hydrophilic gelatin. Compared to RSF screws, the RSF/G screws have better bioactivity and significantly promote cell proliferation, adhesion, spreading and osteogenic differentiation by RGD-integrin interactions via the focal adhesion kinase/extracellular signal-regulated (FAK/ERK) pathway. Eight weeks after implantation in rats, the RSF/G screws with magnetic resonance imaging(MRI) compatibility remained fixed with tight contact, less inflammatory reaction and more new bone formation compared with pure RSF screws. The results indicate great promise for the application of RSF/G screws in bone fracture fixation.

Safety of Contemporary Resorbable Fixation Systems for Craniofacial Reconstruction in Pediatric Patients.

Resorbable hardware allows adequate strength for maintaining the relative position of the craniofacial skeleton during osseous healing, and allowing subsequent growth in pediatric patients. The purpose of this study was to determine the complication profile of the latest copolymer of resorbable plates for craniofacial reconstruction in pediatric patients. Retrospective query of the operative billing record was performed for use of the DePuy Synthes Rapidsorb Fixation System at the authors' tertiary children's hospital from 2015 to 2019. Three hundred twenty-five patients were randomly selected for analysis of complications within the first postoperative year. Median age at craniofacial reconstruction was 3.0 years, with 127 procedures (39.9 percent) performed for an intracranial mass and 141 procedures (44.3 percent) performed for craniosynostosis. Overall, 7.9 percent patients had a postoperative wound complication. The most common complications were dehiscence (3.8 percent), hematoma/seroma (3.5 percent), and infection (2.5 percent). There were no instances of extrusion, plate fracture, or screw loosening. Hardware complications in the temporoparietal region were more likely to occur at incision sites (p = 0.001), whereas wound complications at the frontal region were more likely to occur away from incision sites (p < 0.001). There were no differences in complications between plates secured with resorbable screws or with the resorbable injectable polymer system (p ≥ 0.161 for all). Radiotherapy was significantly implicated in development of clinical infection (p = 0.001), culture-positive infection (p < 0.001), readmission (p = 0.007), reoperation (p = 0.003), and plate removal (p = 0.007). Resorbable cranial hardware has an overall favorable complication profile for craniofacial reconstruction in pediatric patients undergoing surgical intervention for craniosynostosis or intracranial mass resection.

Complications of craniofacial surgery using the ultrasonic-assisted pinned resorbable system: A prospective report with a minimum follow-up of 30 months

Several resorbable fixation systems are used for osteosynthesis in craniofacial surgery. Recently, ultrasonic-assisted pinned resorbable systems have been introduced; however, few studies have described the associated complications during the long-term follow-up until complete resorption. In this study, we investigated the complications of craniofacial surgery using the ultrasonic-assisted pinned resorbable system with a follow-up of at least 30 months. Among patients who underwent craniofacial surgery using a commercially available ultrasonic-assisted pinned resorbable system between 2014 and 2016, those with follow-up visits for at least 30 months were included in this study. We investigated the development of complications such as local infection, exposure of the device, and reoperation related to the implant. Twenty-four patients aged 6 months to 69.4 years (median: 3.5 years) were followed up for more than 30 months. None of the patients required reoperation regardless of implants. Further, no infection or device exposure was seen among all patients. However, two patients aged 6 and 22 months who underwent cranioplasty for craniosynostosis and another patient aged 148 months who underwent cranioplasty for cranial defect exhibited plate-related bulging in the scalp during the course of resorption between 7 and 12 months of follow-up. The bulges were characterized by swelling without pain or redness and resolved spontaneously within 18 months of follow-up, which was considered to occur after complete absorption of the plate. In conclusion, subcutaneous swelling is related to resorbable plates and has a benign clinical course. We recommend that patients be informed of this phenomenon preoperatively to relieve their anxiety.

Mechanical analysis of cranial distractor attachment with three different resorbable fixation systems

Distraction osteogenesis (DO) has become increasingly popular to correct craniosynostosis. Disadvantages of DO include the secondary operation needed for device removal and titanium screw related dura injury. To reduce invasiveness of the secondary device removal operation and to overcome titanium-related problems, fixation of the cranial distractor with resorbable materials is a potential alternative. New resorbable fixation methods, such as ultrasound-activated pins (UAPs) or heat-activated pins (HAPs), allow faster attachment on thinner bone than conventional resorbable screws (CRSs) since tapping is not required. However, resorbable materials are designed to be attached with a resorbable plate, not with a titanium distractor.We evaluated the suitability of CRSs, HAPs and UAPs for the cranial distractor fixation in a laboratory setting with a mechanical testing machine. Fracture tests were conducted in two directions with respect to the longitudinal axis; vertical i.e. axial pull-out strength, and horizontal i.e. shear strength. Mean maximum pull-out strength for CRS, HAP and UAP was 48.9 N, 32.5 N and 14.7 N, respectively. Mean maximum shear strength for CRS, HAP and UAP was 40.8 N, 77.9 N and 38.9 N, respectively. According to our in vitro tests, the cranial distractor attachment with four CRSs or six HAPs per footplate would provide sufficient fixation stability.

Does fixation method affects temporomandibular joints after mandibular advancement?

PurposeSagittal split ramus osteotomy (SSRO) is a standard procedure in which miniplates and screws are used to achieve stabilization. Although the titanium plate and screw fixation system is stable, resorbable fixation systems are also used. There is currently no consensus on the ideal fixation technique for SSRO procedures and its effect on the condyle. We aimed to evaluate the stress distribution on temporomandibular joints (TMJ). MethodsA 3D finite element model of a hemimandible was designed and 5 mm advancement was simulated on a computer model. Four different fixation techniques were applied: inverted-L shaped bicortical screws, L-shaped bicortical screws, miniplate with monocortical screws, and miniplate with monocortical screws and bicortical screw. Computer models were prepared twice for resorbable and titanium material. Load of 600N and muscle forces were applied. In the finite element analysis, computer models simulated and analyzed stress distribution of bone, fixation materials and condyle. ResultsBicortical screws increase the total stress on TMJ, and the stress is located more on the posterior part than the anterior. Miniplates decrease the stress, and the forces are located more on the anterior aspect of the TMJ. ConclusionAccording to our analysis, the use of bicortical screws increases the stress amount on the condyle. For the patients with a tendency toward temporomandibular disorders, using miniplate fixation techniques may decrease the forces around the condyle. These findings should be useful for oral surgeons when deciding on the most appropriate fixation technique in patients with a tendency toward temporomandibular joint disorders.

Use of Resorbable Fixation System in Pediatric Facial Fractures.

Resorbable fixation system (RFS) is an alternative to titanium in open reduction and internal fixation of pediatric facial fractures. This study retrospectively reviewed all medical records in a major metropolitan pediatric hospital in Cape Town, South Africa from September 2010 through May 2014. Inclusion criteria were children under the age of 13 with facial fractures who have undergone open reduction and internal fixation using RFS. Intraoperative and postoperative complications were reviewed. A total of 21 patients were included in this study. Twelve were males and 9 were females. Good dental occlusion was achieved in all patients and there were no complications intraoperatively. Three patients developed postoperative implanted-related complications: all 3 patients developed malocclusions and 1 developed an additional sterile abscess over the right zygomatic bone. For the latter, incision and drainage was performed and the problem resolved without additional operations. Resorbable fixation system is an alternative to titanium products in the setting of pediatric facial fractures without complications involving delayed union or malunion. The combination of intermaxillary fixation and RFS is not needed postoperatively for adequate fixation of mandible fractures. Resorbable fixation system is able to provide adequate internal fixation when both low-stress and high-stress craniofacial fractures occur simultaneously.

Comparison and validation of finite element analysis with a servo-hydraulic testing unit for a biodegradable fixation system in a rabbit model

The aim of this study was the biomechanical validation of three-dimensional finite element analysis (FEA) with a servo-hydraulic testing unit (STU) for a resorbable fixation system (RFS) in a rabbit model. Bilateral mandibular vertical body osteotomies (BMVBO) were performed in 15 female New Zealand rabbits. The animals were divided into three groups. The STU and FEA tests were done immediately after surgery in group 1 (1day), at the first postoperative month in group 2, and at the third postoperative month in group 3. Both stress tests were carried out by applying vertical forces at the lower incisal edge, loading from 0N force and increasing this until breakage occurred at the bone. The maximum forces that the hemimandibles could stand and the amount of deformation were recorded and analysed with the FEA and STU tests. We found the STU and FEA test results to be similar and that they could be used interchangeably for groups 1 and 3. However, the FEA results differed most from the real STU values in group 2 because of callus formation that had not ossified at the osteotomy line.

Salvation for Hardware Failure of Resorbable Fixation Plates in Bilateral Mandibular Angle Fractures

The resorbable fixation system is used for the treatment of facial bone fractures and has many merits. It does not require a fixture removal procedure and is biologically nontoxic. Also, it does not disturb normal growth in growing children. However, there are also many points to be considered, such as resorption time, foreign body reaction, infection rate, or fixation stability depending on the fracture pattern. Because of these factors, there is still controversy over the use of a resorbable system.We present a case of a patient who experienced malunion after using a resorbable fixation system to treat bilateral mandibular angle fracture, which was recovered by corrective osteotomy and vertical ramus osteotomy in our department.

Ultrasonic Resorbable Fixation (Sonic Weld) in Augmentation Eminoplasty With Calvarial Grafts for Recurrent TMJ Dislocation

To assess long-term efficacy and performance of SonicWeld ultrasonic resorbable fixation (KLS Martin, Germany) system in augmentation eminoplasty (Dautrey's procedure) with calvarial block grafts for recurrent condylar dislocations. 5 female patients with mean age of 48 years were operated under nasotracheal general anesthesia. Preoperative 3-D reconstruction CT images were obtained and resorptions of articular eminences were assessed by Mimics software (Materialise, Belgium). Mean vertical height of articular eminences was 6 mm vertically. Hemicoronal flaps were raised accordingly to skeletonize the temporo-parietal calvarium and the articular eminence of zygomatic bone. One patient underwent bilateral augmentation while others had unilateral operations. A standard Dautrey's approach was performed with a sagital saw (NSK, Japan) and the eminences were fractured transversely. The calvarial grafts were harvested according to planned augmentation of articular eminences and tapped into osteotomy sites. SonicWeld pin 13-mm in length was used to fix the inferior osteotomized segment with a harvested calvarial graft to the superior stump. Dietary restriction and soft diet (Regime I) was prescribed to all patients for 4 weeks. Objective analysis with patient follow-up using CT scans and mouth opening (12 months). All inferior bone stumps and interpositional calvarial grafts were fixed satisfactorily with a SonicWeld pin. Acute positive response from operations was obtained immediately at the early post-op period. None of the patients experienced an episode of dislocation in the following 12 months of post-op period. Mean mouth opening was 31 mm. All patients had transient trismus for 2 weeks immediately after surgeries. Two patients had transient facial nerve neuropraxia for 5 weeks. The mean vertical height of the augmented articular eminences was 1.6 cm. TheSonicWeldpins resorbed completely at the 1st year follow-up CT scans. Fixation of cortical calvarial grafts in augmentation eminoplasty with SonicWeld system offers few advantages such as complete resorption of screws at augmented region in particular period and adequate fixation of osteotomy stumps and interpositional grafts avoiding intermaxillary fixation.

Fractured Facial Bone Reduction and Resorbable Plate Fixation Using Tapper

A resorbable fixation system has many advantages, but there are complicated procedures to be accomplished to fix a resorbable plate. The complicated procedures in the fixation of a resorbable plate make the operation for facial fractures more difficult and can result in extended operation time and incomplete reduction or fixation. For these reasons, we suggest a new way of using a tapper that can make the surgery more simple and accurate than before. After the resorbable plate is properly located above the fractured site, a hole on the fracture fragment is made by drill, and the tapper is inserted into the hole. When the tapper is inserted at the proper depth, the fracture fragment can be reduced to right place by handling the inserted tapper. Then, the tapper is inserted to the end, and the handle is split. While the inserted tapper acting as a temporary metal screw is placed, another hole is made at nearby site and the screw is inserted. Next, the inserted tapper acting as a temporary metal screw is removed, and another screw is inserted into the hole from which the tapper was removed. From October 2006 to April 2008, we applied this procedure to 106 facial bone fractures in 68 patients, and no major complications were noted. In conclusion, we tried to make the operation more simple and accurate by using the tapper as an instrument for reduction and fixation of fracture fragment.

Evaluation of in vitro resistance of titanium and resorbable (poly-l-dl-lactic acid) fixation systems on the mandibular angle fracture

The purpose of this study was to compare, by mechanical in vitro testing, a 2.0-mm system made with poly-L-DL-lactide acid with an analogue titanium-based system. Mandible replicas were used as a substrate and uniformly sectioned on the left mandibular angle. The 4-hole plates were adapted and stabilized passively in the same site in both groups using four screws, 6.0mm long. During the resistance-to-load test, the force was applied perpendicular to the occlusal plane at three different points: first molar at the plated side; first molar at the contralateral side; and between the central incisors. At 1mm of displacement, no statistically significant difference was found. At 2mm displacement, a statistically significant difference was observed when an unfavourable fracture was simulated and the load was applied in the contralateral first molar and when a favourable fracture was simulated and the load was applied between the central incisors. At the failure displacement, a statistically significant difference was observed only when the favourable fracture was simulated and the load was applied on the first molar at the plated side. In conclusion, despite more failure, the poly-L-DL-lactic acid-based system was effective.

S421: Management of Craniomaxillofacial Trauma With Bioresorbable Fixation Systems

Surgical treatment of fractures involving the midface, zygoma, orbital floor, and frontal sinus involved the use of metallic and resorbable fixation systems. Other indications include management of craniosynostosis and TMJ disorders. Traditionally, the resorbable systems require tapping into bone and can therefore hamper a successful outcome. The application of an innovative piezoelectrical guided resorbable osteosynthesis system (SonicWeld) that is based on the principle of angle-stability is an approach to overcome this problem. The angle stability is based on melting and bone-welding characteristics of the resorbable material. The decreased mechanical properties that are inherent to resorbable materials can be overcome by this stable plate-pin complex. Compared to resorbable screws the three-dimensional weld pins provide a clearly more stable connection.

Comparison of Fixation Stability of Resorbable Versus Titanium Plate and Screws in Mandibular Angle Fractures

The aim of this study was to compare the fixation reliability and stability of titanium and resorbable plates and screws by simulating chewing forces. Mandibular angle fractures in 11 sheep hemimandibles were fixed with 4-hole straight titanium plates and 2.0 x 7-mm titanium screws; in addition, 11 hemimandibles were fixed with 4-hole straight resorbable plates and 2.5 x 6-mm resorbable screws according to the Champy technique. The hemimandibles were mounted with a fixation device in a servohydraulic testing unit for compressive testing. Displacement values under 20, 60, 100, 120, 150, and 200 N; maximum displacements; and maximum forces that the model could resist before breakage were recorded and compared. Significant differences were found between resorbable and titanium plates and screws at all forces (20, 60, 100, 120, 150, and 200 N) (P < .05). We found no statistically significant differences in the breaking force and maximum displacement values (displacement values at the breaking forces) between the groups. The stability of mandibular angle fractures with titanium miniplates under simulated chewing forces was significantly higher than with the resorbable system. Metallic and resorbable fixation systems cannot be used interchangeably to treat mandibular angle fractures under similar loading conditions.

Comparison of Stability of Resorbable and Titanium Fixation Systems by Finite Element Analysis After Maxillary Advancement Surgery

In this study, three-dimensional modeling and finite element analysis were used to evaluate and compare the stability of Le Fort I osteotomy fixed with titanium and resorbable fixation systems under molar and incisor bite forces. A three-dimensional model of 5-mm advanced hemimaxilla was generated. Contact analyses between the upper and lower segments were prescribed. Two L-plates were inserted on this model via simulation. Displacement, principal stresses, and principal elastic strains were evaluated under 44-N, 125-N incisor and, 250-N molar bite forces. These results suggest that Le Fort I osteotomies fixed with titanium miniplates and screws were stable under all tested forces. However, in resorbable group, under incisor bite forces greater than 44 N, there is a great risk of plate fracture, screw deformation, and/or failure.

Choice of Internal Rigid Fixation Materials in the Treatment of Facial Fractures

The surgical treatment of craniomaxillofacial trauma involves the restoration of both form and function via a complex interplay between the facial bony skeleton and its soft tissue envelope. However, it was not until the introduction of open reduction and internal rigid fixation techniques for the facial skeleton that the basic orthopedic principles of accurate fracture reduction, bone fixation, and healing could be applied. The latter introduced the unprecedented ability to repair unstable and/or displaced bony fractures of the face, providing a stable foundation upon which to reestablish preinjury soft tissue contour. Advances in the science of internal fixation, improvements in available plating materials and equipment, refinements in exposures to the facial skeleton, and an increase in the volume of facial trauma all fueled the rapid expansion of use of rigid internal fixation for facial fractures in the 1980s.1 With growing experience, surgeons came to appreciate the utility of metallic internal rigid fixation systems, along with the potential pitfalls and complications.2,3,4,5 In addition, the permanence of metallic implants spawned questions of long-term safety,2,5,6,7,8 rates and need for removal,3,9,10 and risks in the growing pediatric skeleton.11,12,13,14,15 Aimed at addressing these concerns, manufacturers began research and development of resorbable rigid fixation systems, which more recently are gathering interest in the management of facial trauma. With this in mind, the authors have attempted to summarize and compare the current data describing use of either metallic or resorbable fixation systems for the treatment of facial fractures in an effort to educate surgeons faced with selecting between these two options. Factors such as complication rates, cost, efficacy, and availability are all considered and summarized in this article.

Resorbable versus titanium plates for facial fractures

Rigid internal fixation of the jaw bones is a routine procedure for the management of facial fractures. Titanium plates and screws are routinely used for this purpose. The limitations of this system has led to the development of plates manufactured from bioresorbable materials which, in some cases, omits the necessity for the second surgery. However, concerns remain about the stability of fixation and the length of time required for their degradation and the possibility of foreign body reactions. To compare the effectiveness of bioresorbable fixation systems with titanium systems for the management of facial fractures. We searched the following databases: The Cochrane Oral Health Group's Trials Register (to 20th August 2008), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 3), MEDLINE (1950 to 20th August 2008), EMBASE (from 1980 to 20th August 2008), http://www.clinicaltrials.gov/ and http://www.controlled-trials.com (to 20th August 2008). Randomised controlled trials comparing resorbable versus titanium fixation systems used for facial fractures. Retrieved studies were independently screened by two review authors. Results were to be expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors. The search strategy retrieved 53 potentially eligible studies. None of the retrieved studies met our inclusion criteria and all were excluded from this review. One study is awaiting classification as we failed to obtain the full text copy. Three ongoing trials were retrieved, two of which were stopped before recruiting the planned number of participants. In one study, the excess complications in the resorbable arm was declared as the reason for stopping the trial. This review illustrates that there are no published randomised controlled clinical trials relevant to this review question. There is currently insufficient evidence for the effectiveness of resorbable fixation systems compared with conventional titanium systems for facial fractures. The findings of this review, based on the results of the aborted trials, do not suggest that resorbable plates are as effective as titanium plates. In future, the results of ongoing clinical trials may provide high level reliable evidence for assisting clinicians and patients for decision making. Trialists should design their studies accurately and comprehensively to meet the aims and objectives defined for the study.

Bicortical Biodegradable Screws for Rigid Fixation of Traumatic Sagittal Split Mandibular Fracture

Rigid fixation is the most important issue in the bone healing process. Although internal metallic bone fixation has become increasingly popular over the past 10 years, the presence of several potential problems of metallic bone implants with the popularity of the use of biodegradable plates and screws for craniomaxillofacial fixation have increased in the last 10 years. Rigid fixation of bony fragments was achieved by bicortical applied biodegradable screws in a patient with a sagittal oblique mandibular fracture. Precise bone reduction was maintained with bicortical applied biodegradable screws in the postoperative period. The postoperative period was uneventful and the patient retained the intraoperatively achieved perfect occlusion within a 9-month follow-up period. In this particular case, the advantages of use of resorbable fixation systems are combined with the advantages of bicortical screw fixation of split osteotomy without sacrificing the stability of rigid fixation.

Resorbable fixation in facial plastic and head and neck reconstructive surgery: an initial report on polylactic acid implants.

The purpose of this study was to evaluate and report our initial experience with a resorbable fixation system in facial cosmetic and head and neck reconstructive surgery. The specific goals were to determine in which settings the absorbable system could be used, to evaluate the outcome of its use, to detail complications that occurred, and to report our observations on advantages and disadvantages of the system compared with traditional methods of osteosynthesis and fixation. A retrospective review of the initial 30 consecutive patients at the University of California, San Diego Division of Head and Neck Surgery who received polylactic acid (PLA) implants. Academic tertiary referral/level I trauma center. Criteria for inclusion into the study were any patient over age 18 who underwent a procedure involving the use of a PLA implant between March 1999 and October 2000. In addition to the typical indications for metal plate or mesh implantation, PLA was used for "protected bone regeneration." Detailed records were kept of all patients in whom PLA implants were used, including the exact procedure and type of implant. All patients were operated by the authors. Operative reports, hospital charts, and office records were analyzed for any perioperative or postoperative complications. The attending surgeon noted advantages and disadvantages of the system. Patients have been followed from 2 to 18 months at the time of this report and are part of an ongoing long-term follow-up study. PLA implants were used in 35 procedures on 30 consecutive patients (multiple unilateral fracture repairs were counted as a single procedure). Uses included fixation of craniofacial fractures (zygomaticomaxillary, orbit floor, frontal bone [N = 9]; fixation of craniofacial osteotomy [N = 8]; protected bone regeneration [N = 3]; mandible, cranial bone donor site [N = 2]; bone grafting [N = 2]; craniectomy reconstruction [N = 2], and soft tissue suspension [endoscopic browlifting, N = 6, static facial suspension, N = 1]). There were 4 complications in this series: 2 partial flap losses, 1 in a patient who had had preoperative radiation and the other in a heavy smoker; 1 infected cranial bone flap in a patient who had had two prior surgeries and radiation; and 1 wound dehiscence over a plate that was improperly contoured. Advantages noted by the surgeons were ease of contouring the mesh or plates, including in situ reshaping, apparent decrease in operative time, low implant profile, minimal soft tissue reaction, and radiolucency of the system, allowing postoperative imaging without metallic artifact. We found the PLA system to be highly effective, and noted no absolute contraindications to its use compared with standard metal plating systems. The 11% incidence of complications in this series was acceptable and probably not the result of the PLA implant material, although further experience is needed to determine the role of PLA implants in radiated tissue. The primary advantages to PLA appear to be its ease of use, radiolucency, eventual resorption, and, possibly, improved precision of reduction. The use in protected bone regeneration may also be an advantage, but long-term follow-up of our population will be needed to determine this. Based on short-term outcome analysis of our initial experience with PLA implantation, it appears to be an efficacious and safe technology for applications in head and neck and facial plastic surgery.