Use Of Bioabsorbable Material Research Articles

Pitfalls and promises of bile duct alternatives: There is plenty of room in the regenerative surgery.

Current abdominal surgery has several approaches for biliary reconstruction. However, the creation of functional and clinically applicable bile duct substitutes still represents an unmet need. In the paper by Miyazawa and colleagues, approaches to the creation of bile duct alternatives were summarized, and the reasons for the lack of development in this area were explained. The history of bile duct surgery since the nineteenth century was also traced, leading to the conclusion that the use of bioabsorbable materials holds promise for the creation of bile duct substitutes in the future. We suggest three ideas that may stimulate progress in the field of bile duct substitute creation. First, a systematic analysis of the causative factors leading to failure or success in the creation of bile duct substitutes may help to develop more effective approaches. Second, the regeneration of a bile duct is delicately balanced between epithelialization and subsequent submucosal maturation within limited time frames, which may be more apparent when using quantitative models to estimate outcomes. Third, the utilization of the organism's endogenous regeneration abilities may enhance the creation of bile duct substitutes. We are convinced that an interdisciplinary approach, including quantitative methods, machine learning, and deep retrospective analysis of the causes that led to success and failure in studies on the creation of bile duct substitutes, holds great value. Additionally, more attention should be directed towards the balance of epithelialization and submucosal maturation rates, as well as induced angiogenesis. These ideas deserve further investigation to pave the way for bile duct restoration with physiologically relevant outcomes.

Treatment of traumatic rib fractures: an overview of current evidence and future perspectives.

Operative management of rib fractures has gained significant popularity over the last years, however, it remains a controversial topic, due to the substantial heterogeneity among rib fracture patients with considerable differences in epidemiology. Hence, the present narrative review aims to provide an overview of the treatment and (long-term) outcomes of rib fractures, with an emphasis on the surgical treatment. Nowadays, computed tomography (CT) has been shown to be most practical and sensitive for detecting rib fractures, of which up to 50% is missed on other imaging modalities. Non-operative treatment by patient-tailored multimodal pain management remains the cornerstone. Still, in the presence of-amidst others-chest wall instability or displaced fractures with physiologic derangements, operative treatment is indicated and should be performed within 72 hours after injury. Here, traumatic brain injury (TBI) and pulmonary contusion are no strict contra-indications, while plate osteosynthesis is considered the standard mode for surgical stabilization. To date, surgical stabilization of rib fractures (SSRF) only benefits selected groups of patients, awaiting results of ongoing studies. Future directions may include the sole use of percutaneous cryoablation of the intercostal nerves as part of conservative management, as well as the application of three-dimensional (3D) printing and use of bio-absorbable materials in the surgical treatment of rib fractures.

Zastosowanie śrub biowchłanialnych w porównaniu ze śrubami metalowymi w truamatologii dziecięcej

ABSTRACTIntroduction: Metal stabilizing implants used in pediatric fractures have to be removed to not inhibit the growth of bones. Bioabsorbable implants can save children from surgical removal of the fixating material. As there have been only a few reports regarding children, we decided to evaluate the clinical advantages of bioabsorbable screws in the treatment of selected bone fractures in pediatric traumatology.Materials and methods: The study group included 35 patients with bone fractures aged 5–17 years (mean 13.2 years) fixed with LactoSorb® bioabsorbable screws made of polymeric lactic acid and polyglycolic acid. The follow-up was compared with a matched control group of 35 children that underwent operative fixation of the same type of fractures with metal screws. Results: Clinical and radiological follow-up showed that bone unions were obtained in all cases, with no signs of osteolysis. The time of immobilization was slightly shorter in the study group (5.5 weeks) than among controls (6.2 weeks; p = 0.038). There were no differences in complications, wound infections, pain management and time of hospitalization between both groups.Conclusions: The use of bioabsorbable material in the treatment of fractures in pediatric traumatology is a safe alternative to metal stabilizing devices, with clinical benefits for young patients including no necessity of a second surgery and anesthesia.

Is the use of bioabsorbable materials in Orthopaedic Surgery associated with Infections? An experimental study in rabbits and review of the literature.

Bioabsorbable materials have been extensively used in medicine. Many have suggested the use of these implants for treating fractures as well as other orthopaedic conditions since they may lead to less implant morbidity , and they have additional advantages: they are radiolucent, they eliminate hardware removal procedures, they limit stress-shielding and they gradually transfer load to healing fractures. Despite the popularity of these implants, reports of complications continue to appear in the literature. Although these complications have rarely adverse effect on the long term outcome they are quite frequent and have been reported with most of the commercially available implants with varying incidence rates and reactions to them. The purpose of this review is to summarize the infections reported in clinical trials of bioabsorbable materials.

Fijación de tórax inestable con placas y tornillos bioabsorbibles. Presentación de serie de casos

BackgroundFlail chest is managed with mechanical ventilation or inhalation therapy, and analgesia. Mechanical ventilations carry risks by themselves, and disengage with the external fixators, so they must be operated to improve lung ventilatory mechanics and cleaning. Little has been published on the use of bio-absorbable material and its evolution in the setting of flail chest. Material and methodsA study was made on a material that did not have to be removed, that had the malleability of steel, its inflammatory reaction was minimal, and could be handled in both adults and children. A descriptive study is presented of patients with flail chest under rib fixation with plates and bio-absorbable screws. ResultsA series of 18 cases are presented, with ages from 33-74 years, three with bilateral flail chest. Fixation was performed between days 1-21 of the accident. In cases that showed no fractures of pelvic limbs, walking was restarted the day after fixing. In all cases mechanical ventilation improved and pain decreased. So far there has been no reaction to the material. ConclusionsFlail chest has a high (16.3%) mortality when the pathophysiology of the condition (pain, poor mechanical ventilation, alveolar oedema-pulmonary contusion) is not treated. The use of bio-absorbable material has no side effects attributable to material, making it another option for rib fixation.

Unstable thorax fixation with bioabsorbable plates and screws. Presentation of some cases1

Background: Flail chest is managed with mechanical ventilation or inhalation therapy, and analge- sia. Mechanical ventilations carry risks by themselves, and disengage with the external fixators, so they must be operated to improve lung ventilatory mechanics and cleaning. Little has been pub- lished on the use of bio-absorbable material and its evolution in the setting of flail chest. Material and methods: A study was made on a material that did not have to be removed, that had the malleability of steel, its inflammatory reaction was minimal, and could be handled in both adults and children. A descriptive study is presented of patients with flail chest under rib fixation with plates and bio-absorbable screws. Results: A series of 18 cases are presented, with ages from 33-74 years, three with bilateral flail chest. Fixation was performed between days 1-21 of the accident. In cases that showed no frac- tures of pelvic limbs, walking was restarted the day after fixing. In all cases mechanical ventila - tion improved and pain decreased. So far there has been no reaction to the material. Conclusions: Flail chest has a high (16.3%) mortality when the pathophysiology of the condition (pain, poor mechanical ventilation, alveolar oedema-pulmonary contusion) is not treated. The use of bio-absorbable material has no side effects attributable to material, making it another option for rib fixation.

Evaluation and management of injuries of the tibiofibular syndesmosis.

Injury to the tibiofibular syndesmosis often arises from external rotation force acting on the foot leading to eversion of the talus within the ankle mortise and increased dorsiflexion or plantar flexion. Such injuries can present in the absence of a fracture. Therefore, diagnosis of these injuries can be challenging, and often stress radiographs are helpful. Magnetic resonance imaging scans can be a useful adjunct in doubtful cases. The management of syndesmotic injuries remains controversial, and there is no consensus on how to optimally fix syndesmosis. This article reviews the mechanism of injury, clinical features and investigations performed for syndesmotic injuries and brings the reader up-to-date with the current evidence in terms of the controversies surrounding the management of these injuries. Embase, Pubmed Medline, Cochrane Library, Elsevier and Google Scholar (January 1950-2014). The management of syndesmotic injuries remains controversial, and there is no consensus on: (i) which ankle fractures require syndesmotic fixation, (ii) the number or the size and the type of screws that should be used for fixation, (iii) how many cortices to engage for fixation, (iv) the level of screw placement above the ankle plafond, (v) the duration for which the screw needs to remain in situ to allow the tibiofibular syndesmosis to heal and (vi) when should patients weight bear. (i) A high proportion of syndesmotic fixations demonstrates malreduction of the syndesmosis, (ii) no need to remove screws routinely, (iii) two screws appear to better one alone and (iv) if syndesmosis injury is not detected or not treated long term, it leads to pain and arthritis. (i) How to assess the adequacy of syndesmotic reduction using imaging in the peri-operative period, (ii) the use of bio-absorbable materials and Tightrope and (iii) evidence is emerging not to remove syndesmotic screws unless symptomatic. (i) A bio-absorbable material that can be used to fix the syndesmosis and allow early weight bearing, and (ii) there is a need for developing a surgical technique for adequately reducing the syndesmosis without the exposure to radiation.

A contemporary snapshot of the use of hydroxyapatite coating in orthopaedic surgery

The capacity for biological materials to combine with inorganic salts is well established. Bio-mineralisation was an evolutionary milestone, and a key contributor to the ‘cladogenesis of life’ which occurred in the early Cambrian period, 570 million years ago.[1][1] A protracted ice age in the

Guided bone regeneration for immediate non-submerged implant placement using bioabsorbable materials in Beagle dogs.

The aim of the present study was to evaluate the combined application of different bioabsorbable materials for healing of residual peri-implant defects after placement of non-submerged implants into fresh extraction sockets. Second and third mandibular premolars were extracted from 10 Beagle dogs, the coronal part of the distal sockets were surgically enlarged and this was followed by immediate placement of specially designed hollow-screw non-submerged dental implants. For each animal, the coronal peri-implant defects were further treated with one of the 4 following procedures: 1) no treatment, control site; 2) grafting with porous hydroxyapatite (HA); 3) collagen membrane tightly secured around the implant and over the defect and 4) grafting with HA covered with a collagen membrane. After 16 weeks of healing, specimens were removed from the mandibule and prepared for a histomorphometric evaluation. The bone-to-implant contact length (BIC) was measured and compared amongst the different treatment modalities. In the defect area, the irregular bone regeneration was similar between all the treatment procedures (P > 0.10). In the sites covered with a collagen membrane alone, the total BIC (47%) was greater than in control sites (28.7%, P < 0.05) or sites grafted with HA (22.2%, P < 0.02). Total BIC in sites treated with the HA-membrane combination (43%) was only significantly different from sites treated with HA (P < 0.05). It is concluded that the use of bioabsorbable materials results in a limited increase of osseointegration when used in conjunction with immediate placement of non-submerged implants, although the principle of the one stage surgical approach can be maintained.