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Bioabsorbable System-Related Subcutaneous Swelling After Craniofacial Surgery
Yoshiaki Sakamoto1, Tomoru Miwa2, Masahiro Toda2
1Department of Plastic and Reconstructive Surgery.
Insights
Subcutaneous swelling is a complication of bioabsorbable plates used in pediatric cranioplasty. While both poly D-lactic acid/polyglycolic acid and poly D-/L-lactic acid systems can cause swelling, careful follow-up is essential for all patients.
Area of Science:
- Pediatric Surgery
- Biomaterials Science
- Craniofacial Surgery
Background:
- Bioabsorbable systems are widely used for pediatric cranioplasty.
- Subcutaneous swelling is a known complication of bioabsorbable osteosynthesis.
- The comparative incidence of swelling based on different bioabsorbable materials remains unclear.
Purpose of the Study:
- To compare the incidence of subcutaneous swelling associated with different bioabsorbable materials used in pediatric cranioplasty.
- To analyze the occurrence and resolution of subcutaneous swelling in patients undergoing craniosynostosis repair with resorbable systems.
Main Methods:
- Retrospective review of patients undergoing primary cranioplasty for craniosynostosis (2014-2018).
- Analysis of subcutaneous swelling incidences over a 12-month follow-up period.
- Systematic review of published English-language literature on bioabsorbable systems for craniosynostosis since 1995.
Main Results:
- Two common bioabsorbable material groups were identified: poly D-lactic acid/polyglycolic acid and poly D-/L-lactic acid.
- Poly D-lactic acid/polyglycolic acid systems showed 0%-4.2% swelling incidence (3-9 months follow-up).
- Poly D-/L-lactic acid systems showed 5%-16.7% swelling incidence (6-12 months follow-up); all resolved spontaneously.
Conclusions:
- Determining the definitively superior material for reducing swelling was challenging due to study variations.
- Subcutaneous swelling is an inherent risk with all investigated resorbable systems.
- Preoperative patient counseling and diligent follow-up are crucial for managing this complication.
Background:
Bioabsorbable systems have been commonly used in pediatric patients for primary cranioplasty and other related surgeries. However, subcutaneous swelling, a unique complication related to bioabsorbable osteosynthesis, is a concern. Differences in the incidence of subcutaneous swelling, depending on the bioabsorbable material used to construct the plate, are still unknown.
Methods:
The authors retrospectively reviewed all incidences of subcutaneous swelling related to resorbable systems used during primary cranioplasty for patients with craniosynostosis at their hospital between 2014 and 2018 during a 12-month follow-up period. Furthermore, the authors reviewed all published English-language articles (since 1995) on subcutaneous swelling in bioabsorbable systems used for craniosynostosis.
Results:
The most common resorbable systems used in the literature were divided into 2 groups: mixtures of poly D-lactic acid and polyglycolic acid, and mixtures of poly D- and L-lactic acid. In patients for whom poly D-lactic acid and polyglycolic acid were used, the incidence of subcutaneous swelling during resorption was 0% to 4.2% between 3 and 9 months of follow-up. In patients for whom poly D- and L-lactic acid was used, subcutaneous swelling during resorption occurred in 5% to 16.7% of these patients between 6 and 12 months of follow-up. All cases resolved spontaneously after complete absorption of the plate.
Conclusions:
It was difficult to determine which system had the lowest incidence of subcutaneous swelling. The thickness of each resorbable system and the thickness of the infants' scalps were different in each study. However, subcutaneous swelling occurred in every resorbable system. Therefore, preoperative counseling and careful follow-up are necessary.
