Use Of Alloplastic Material Research Articles

Can Alloplastic Total Temporomandibular Joint Reconstruction be Used in the Growing Patient? A Preliminary Report

Although primarily reserved for adult patients, temporomandibular joint (TMJ) total joint reconstructive (TJR) surgery is rarely used in the pediatric population due to its many challenges; it is only performed after all other non-invasive or invasive procedures have been exhausted. Although autogenous grafting has been discussed in the literature, there is very little regarding synthetic or alloplastic materials. In this study, we performed alloplastic TMJ reconstruction on 5 patients with severe ankylosis due to various craniofacial deformities and prior traumatic injuries. This is a retrospective case series analysis of skeletally immature patients who received alloplastic TMJ reconstruction for recurrent and advanced ankylosis. Our inclusion criteria were as follows: less than 16 years of age, diagnosis of TMJ ankylosis, skeletally immature patients, and unilateral/bilateral total alloplastic TMJ reconstruction. We used the maximum incisal opening (MIO) changes as 1 component to assess for functional improvement. Since many of these cases involved gross discrepancies from the normal variants, it was difficult to quantitatively compare the patients with one another. Nevertheless, we used cephalometric analysis to compare pre- and postoperative results on each patient. For this study, we used MIO as our primary assessment: the preoperative average for MIO was 7.4 mm, and the postoperative average 24 mm. It is our experience that the use of alloplastic material will not result in harm to either the growth of the mandible or patient's ability to achieve an improved MIO based on our long- and short-term results. These results demonstrate that for even complex craniofacial deformities and traumatic injuries, our patients experienced a significant improvement in MIO, 1 of the main indicators for TMJ function. We conclude that the alloplastic joint can provide a predictable pathway to restore patient's MIO and obviate the need for repeated surgeries, which can be a more challenging alternative with poorer outcomes.

Split Calvarial Graft Reconstruction for Growing Skull Fracture in Pediatrics

AbstractBackground: Growing skull fracture is a rare but well-known complication of skull fracture in infancy and early childhood. The definitive treatment is Duro-cranioplasty. The use of alloplastic material in cranial reconstruction has been well described in adult but in children it is hesitation about the safety of nonexpansible alloplastic material.Aim of Study: This is a retrospective study to evaluate autologous split thickness skull grafts and cranioplasty for treatment of growing skull fractures in pediatrics.Patients and Methods: This is a retrospective study of complicated calvarial fractures presented at Mansoura Uni-versity Hospital from 2015 to 2018 and included 10 patients with growing skull fractures. All patients underwent autologous cranioplasty of the skull defect secondary to growing skull fracture after duroplasty.Results: The age at injury ranged from 5M-6 years. The cause of these fractures included falls and vehicle accident. On average, progressive swelling was diagnosed 7 months after the initial injury. The size of the cranial defects was average 3 X 3cm after restoration of dural contour (duroplasty). Six patients (60%) needed blood transfusion. Follow-up for patients was an average of 6 months. All patients showed post-operative bone fusion without evidence of complications.Conclusion: The concern for growth restriction or implant instability in a growing pediatric skull also the cost, limit the use of alloplastic materials. Our data show that autologous bone grafting is the standard in pediatric population regarding the safety and cost with limited post-operative complications. Moreover, early recognition is crucial in the management of GSFs to avoid the progression of neurological consequences and skull deformities.

Post-Neurosurgical Temporal Deformities: Various Techniques for Correction and Associated Complications.

An irregular craniofacial contour along the temporal fossa, known commonly as 'temporal hollowing deformity,' (THD) can arise from multiple etiologies. In fact, up to half of all patients who undergo neurosurgical pterional dissections develop some form of temporal contour deformities. Unfortunately, temporal hollowing correction remains surgically challenging with many techniques resulting in high rates of failure and/or morbidity. Herein, we describe anatomy contributing to postsurgical temporal deformity as well as time-tested prevention and surgical correction techniques. In addition, a review of 25 articles summarizing various techniques and complication profiles associated with temporal hollowing correction are presented. Complications included infection, implant malposition, revision surgery, pain, and implant removal because of implant-related complications Augmentation with either autologous fat or dermal filler is associated with the highest number of reported complications, including catastrophic events such as stroke, pulmonary embolism, and death. No such complications were reported with use of alloplastic material, use of autologous bone, or free tissue transfer. Furthermore, careful attention to adequate temporalis muscle resuspension and position remain paramount for stable restoration of craniofacial symmetry. Catastrophic complications were associated with injection augmentation of both fat and dermal filler in the temporal region. In contrast, use of alloplastic materials was not found to be associated with any catastrophic complications. As such, for the most severe cases of THD, we prefer to employ alloplastic reconstruction.

Extensive necrotizing fasciitis after fat grafting for bilateral breast augmentation: recommended approach and management.

Extensive necrotizing fasciitis after fat grafting for bilateral breast augmentation: recommended approach and management.

Korrektur der parastomalen Hernie mit Netz

The incidence of parastomal hernia in ileal conduit urinary diversion ranges from 4% to 16%. Surgical correction is necessary in about one third of cases and different techniques of surgical reconstruction have been described. Primary fascial repair has a high recurrence rate of 46-100% whereas stoma translocation is associated with complication rates of up to 88%. The use of alloplastic material (usually polypropylene meshes) has reduced the recurrence rate by up to 100% for primary fascial repair and 71% for stoma translocation down to 33%.Composite meshes consist of two layers, a polypropylene layer and an expanded polytetrafluoroethylene (ePTFE) layer. The former is placed against the abdominal wall for permanent reinforcement by ingrowing connective tissue and the ePTFE layer is placed against the abdominal organs preventing adhesions with the bowel. The intraperitoneal placement of such composite meshes is a standardized, simplified, gentle and controllable surgical procedure. This article reports experiences with the surgical correction of parastomal hernias in ileal conduits using composite meshes.

The IUGA/ICS classification of complications of prosthesis and graft insertion

This is a presentation of case series after the use of alloplasic material in urogynaecology. From 2004 to 2010, a total 179 patients with complications have been referred directly after the use of alloplastic material in incontinence and prolapse surgery. Of this total, 125 patients had a previous vaginal sling plasty because of urinary stress incontinence, while 54 patients underwent a prolapse surgery with mesh use. Symptoms and findings are expressed by the recently introduced International Urogynecological Association/International Continence Society (IUGA/ICS) terminology. The most frequent findings after vaginal sling plasty were bladder outlet obstruction, pain and tape exposure. The most frequent findings after prolapse surgery were pain and mesh erosion. The IUGA/ICS classification does not give the possibility to express functional disorders. Most revisions were done more than 2 months after surgery. After incontinence surgery, mostly the vaginal area of suture line was affected; after prolapse surgery, the vagina and the trocar passage were affected. Mesh complication and affected site after prolapse surgery do differ from those after incontinence surgery. The IUGA/ICS classification of mesh complication facilitates the comparison of mesh complication.

Retro-Orbital Intraconal Fat Injection: An Experimental Study in Rabbits

Despite adequate treatment, enophthalmos due to intraconjunctival corticosteroid injection and enlargement of the bony orbit after trauma remains a frequent complication. The use of alloplastic material in addressing this problem is restricted because it may result in allergic reactions and is not cost-effective. The use of retro-orbital intraconal injection is the most effective method for maximum augmentation. An inexpensive and minimally invasive alternative that also allows for reoperation when needed would be a preferred intervention. We used 24 white rabbits (New Zealand) in our study. The animals were divided into 2 groups: a fat group and a saline solution group. The first group was subjected to retrobulbar fat injection, and the second group underwent physiologic saline solution injection. The volume of the retrobulbar area was measured and statistically evaluated both before and after the injections. Sonographically measured retrobulbar volumes were then statistically analyzed. When the saline solution and fat groups were compared, no significant difference was observed between the preinjection volumes of the orbits. However, after injection, there was a significant difference between volumes. A statistically significant difference was shown between retro-orbital volumes calculated before the injection in the fat group and volumes calculated immediately after injection and in the following 4 months (right retro-orbital volume of 1.291 cm(3) ± 0.031 cm(3) before injection and 2.656 cm(3) ± 0.040 cm(3) in the fourth month, P < .05). Volume augmentation by fat injection is superior to complicated surgical methods because of the advantages of decreased morbidity, rapid rehabilitation, and ease of reinjection. Using fat tissue as a filling material is more reliable, easier, and cheaper in comparison to other implantable materials.

Entwicklung neointimaler Matrix nach Einheilen moderner Prothesen: Vergleich zwischen ePTFE und Dacron

In the therapy for peripheral arterial occlusive disease there remain inadequacies in the use of alloplastic material concerning thrombogenicity and biological compliance. In the 1960s, Sparks tried to combine the advantages of alloplastic prostheses with those of autologous reconstructions by using incorporated prostheses. No extensive myointimal hyperplasia was noted, but besides infections aneurysmatic dilatation were limiting factors in clinical practice. The incorporation of modern alloplastic prostheses without connection to circulation concerning the thickness of neointima as well as the percentage of smooth muscle cells was examined in a dog model. The thickness of the neointima increased significantly in Dacron grafts with a peak on day 70 (p = 0.022), additionally a significantly greater percentage of smooth muscle cells was noted in Dacron grafts after 44 and 58 days (p = 0.008, p = 0.036). Due to the decreased thickness of the incorporating matrix as well as the lower percentage of smooth muscle cells, PTFE grafts should be preferred for peripheral arterial revascularisation.

Tensiometry as a Decision Tool for Abdominal Wall Reconstruction with Component Separation

The recurrence rate for incisional hernias following reconstruction depends not only on the size of the initial hernia or abdominal wall defect but also on the number of the concomitant diseases. The surgical approach chosen and the level of tension affecting the sutures both represent essential indicators of long-term success in abdominal wall reconstruction. Several techniques have been advocated to reconstruct the abdominal wall, either with or without use of alloplastic material. A number of authors even recommended separating the lateral components of the abdominal wall to preserve innervation and blood supply of the advanced parts. This retrospective study is based on a patient collective consisting of 23 patients. In addition to hernias or abdominal wall defects, all of them suffered several concomitant diseases and were treated at the German university hospitals in Erlangen-Nürnberg and Freiburg. All procedures were performed between the years 2000 and 2006. In all cases, reconstruction of the abdominal wall was achieved by employing the separation of components technique by Ramirez. Some of these procedures entailed the use of alloplastic material. Use of this material was based on intraoperative tensiometry results. Surgical outcome was determined by evaluating postoperative complications and the hernia recurrence rate. We achieved complete anatomic reconstruction of the abdominal wall in 61% of cases. Alloplastic mesh was used in 39% of the cases. Results of a long-term follow-up (56 months) revealed that only 18% of patients experienced hernia recurrence. Intraoperative tensiometry provides an additional important parameter for the surgical algorithm. Depending on the results, the appropriate surgical method for each case can be chosen. The decision on whether this procedure entails the use of alloplastic mesh can also be based on intraoperative tensiometry results.

Use of Medpor implants in rhinoplasty surgery

The gold standard for graft material in nasal reconstruction has been autologous tissues such as cartilage from the septum, ear or rib, or bone from the rib, iliac crest or calvarium. However, with the increased demand for revision rhinoplasty, the supply of autologous tissues may be limited, and the use of alloplastic material provides a safe alternative. Medpor, which is a biomaterial composed of porous high-density polyethylene (PHDPE), has proven to be a dependable implant and has been widely used in craniofacial reconstruction and rhinoplasty surgery. Specific qualities of Medpor include: excellent contouring capabilities, prefabricated shape availability, ingrowth of innate vasculature that allows for increased mechanical stability, decreased risk of implant migration, and decreased risk of infection. This article discusses the precise technique utilized for nasal dorsal augmentation with Medpor implants. Emphasis is placed on describing techniques to use to avoid complications related to alloplastic materials. The gold standard for graft material in nasal reconstruction has been autologous tissues such as cartilage from the septum, ear or rib, or bone from the rib, iliac crest or calvarium. However, with the increased demand for revision rhinoplasty, the supply of autologous tissues may be limited, and the use of alloplastic material provides a safe alternative. Medpor, which is a biomaterial composed of porous high-density polyethylene (PHDPE), has proven to be a dependable implant and has been widely used in craniofacial reconstruction and rhinoplasty surgery. Specific qualities of Medpor include: excellent contouring capabilities, prefabricated shape availability, ingrowth of innate vasculature that allows for increased mechanical stability, decreased risk of implant migration, and decreased risk of infection. This article discusses the precise technique utilized for nasal dorsal augmentation with Medpor implants. Emphasis is placed on describing techniques to use to avoid complications related to alloplastic materials.

Homologous vein transplantation in cruropedal arterial reconstruction

Allogenic venous transplantation represents an alternative procedure for preventing leg amputation. This study reviewed the question of whether immunologic monitoring and immunosuppressive therapy provide results close to those of autologous reconstructions. Twenty-eight patients received 31 homologous venous transplants. The average age in this group of 15 women and 13 men was 64.5 years. Limbs in danger of amputation could be kept longer in two thirds of them. These promising results show the superiority of this method over the use of alloplastic material in regions with cruropedal vessels. Therefore, it can be recommended in acute leg ischemia with lack of autologous vascularity. Improving guidelines for indication will be an interesting research field, and more contributions are needed.

Surgical correction of scaphocephaly: experiences with a new procedure and follow-up investigations

Introduction: Simple resection of the sagittal suture and the use of alloplastic material or extensive skull resections have long been proven to be unsatisfactory in the treatment of sagittal synostosis. In contrast to these experiences, the immediate correction of skull shape seems to yield the best results without significant morbidity. Patients: Thirty-six scaphocephalic infants with an average age of 6.5 (3.5–14) months underwent operation by our craniofacial team since 1994. Methods: Wide resection of the sagittal suture was used in combination with a bone-strip resection along the coronal and lambdoid sutures. Occasionally partial resection and reshaping of the frontal or occipital bone was necessary to correct an extremely bulging skull. The cranial growth and shape was monitored by anthropometric skull measurements in the last 20 patients. Results: Except in two cases, in which the dura mater was minimally injured intraoperatively, no complications occurred in any patient. Craniofacial oedema always occurred but disappeared after 72 h. The immediate correction of the skull shape was successful in all cases and was completed within 6 months postoperatively. There was no iatrogenic bone defect one year after surgery. Postoperative skull shape and growth was normal. Conclusion: These procedures seem to be effective in the treatment of scaphocephalus. Further normalization of skull shape is achieved by unrestricted postoperative brain growth.

Abnormal Collagen I to III Distribution in the Skin of Patients with Incisional Hernia

The surgical mesh-free repair of incisional hernias has to face recurrence rates of up to 50%. Apart from technical faults this is probably due to collagen metabolic disorders, known to play an important role in the development of inguinal hernia. In particular an altered ratio of collagen types I and III with an increase in collagen type III has been claimed to reduce the mechanical strength of connective tissues. Therefore, we investigated the content of collagen types I and III in the skin of patients with incisional hernia (n = 7) and recurrent incisional hernia (n = 5) in comparison to controls with healthy skin (n = 7) and normal skin scar (n = 7) both by immunohistochemistry and Western blot analysis. Both immunohistochemistry and Western blot analysis revealed a decrease in the ratio of collagen I/III due to a concomitant increase in collagen III. The patients with incisional hernias and with recurrent incisional hernias showed a ratio of 1.0 ± 0.1 and 0.8 ± 0.1, respectively, whereas the controls exhibit a ratio of 2.1 ± 0.2 in healthy skin and of 1.2 ± 0.2 in normal skin scar, respectively. The decrease was highly significant (p < 0.01) between the patients with either primary or recurrent hernia and the controls or the normal scar, as well as between controls and normal scar, whereas there was not any significant difference between primary and recurrent hernia (p > 0.05). Our data for the first time confirmed that the presence of incisional hernia is accompanied by impaired collagen synthesis in the skin. The decreased tensile strength of collagen type III may play a key role in the development of incisional hernias. Furthermore, it might explain the high recurrence rates of hernia repair by simple closure, as a repetition of the primarily failing technique, and the improvement by the additional use of alloplastic material.

LATE COMPLICATIONS VS. METHOD OF TREATMENT IN A LARGE SERIES OF MID-FACIAL FRACTURES

The late presence of contour defects, as well as one eye being lower than the other, were directly related to a lack of interosseous wire fixation in this series of mid-facial fractures. In orbital floor fractures, the use of alloplastic material was found to give more satisfactory long-term results than bone grafts. The direct approach through the lower lid produced no complications of its own in this series. Associated injuries and preexisting disease were found in 61 percent of these patients, supporting the thesis that an M.D. should direct their care. The late presence of diplopia and/or enophthalmos was directly related to an underestimation and undertreatment of orbital floor fractures, or to treatment with bone grafts. The use of a shoulder strap, in conjunction with the lap belt, seems to almost completely prevent the occurrence of mid-facial fractures in automobile accidents.