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Vol. 22. Num. 6.January 2011Pages 488-607
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Vol. 22. Num. 6.January 2011Pages 488-607
DOI: 10.1016/S1130-1473(11)70105-1
Prospective assessment of complications associated with ultrasound activated resorbable pin osteosynthesis in pediatric craniofacial surgery: preliminary results
Estudio prospectivo evaluando complicaciones de cirugía craneofacial pediátrica usando clavos reabsorbibles activados con ultrasonidos: resultados preliminares
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E. Nkenke??
Corresponding author
emeka.nkenke@uk-erlangen.de

Corresponding author: Department of Oral and Maxillofacial Surgery. Glücksstrasse 11. 91054 Erlangen, Germany.
, E. Vairaktaris, C. Knipfer, F. Stelzle
Departments of Oral and Maxillofacial Surgery
S. Schwarz*, I. Eyüpoglu**, O. Ganslandt**, T. Leis***
* Pathology. University Hospital Erlangen. Erlangen. Germany
** Neurosurgery. University Hospital Erlangen. Erlangen. Germany
*** Pediatrics. University Hospital Erlangen. Erlangen. Germany
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Article information
Summary

Ultrasound activated resorbable pin osteosynthesis (UARPO) has recently shown favourable results in operations on children suffering for craniosynostosis. However, data on complications coming with this new technique in children suffering from craniosynostoses are scarce and have only been assessed retrospectively so far. It has been the aim of the present study to prospectively follow up children undergoing craniosynostosis surgery with a focus on complications related to UARPO materials.

Ten pediatric patients (3 female/7 male) were operated due to craniosynostosis at an average age of 9.1±3.8 months using UARPO (SonicWeld/Resorb-X, KLS Martin, Tuttlingen, Germany). Clinical followup evaluations were carried out 1, 3, 6, 9, 12 and 18 months after surgery according to signs of local infection, stability of the remodeled cranial vault and the palpability of the osteosynthesis material. If secondary surgery was necessary, the indication was documented and evaluated by histological and wound smear examinations.

No intra-operative or postoperative complications during the inpatient period occurred. 3 patients needed secondary operation due to a localized chronic swelling at the former incision site which developed 3, 9 and 12 months after the operation. Histological examinations yielded a giant cell formation surrounding the resorbable materials in all cases. Additionally, the wound smear showed a bacterial infection in one site.

The current prospective study is the first in the field. It reveals a high percentage of delayed foreign body reactions with UARPO, bearing the need of secondary surgery. It seems that this high complication rate found in the present prospective study may weigh out the advantages of UARPO.

Key words:
Craniofacial surgery
Craniosynostosis
Resorbable materials
Ultrasound activated resorbable pin osteosynthesis
Resumen

Recientemente, la osteosíntesis activada por ultrasonografía con clavos reabsorbibles (OAURC) ha demostrado resultados favorables con operaciones en niños que sufren de craneosinostosis. Sin embargo, los datos actuales sobre complicaciones provenientes con esta técnica nueva en niños que sufren de craneosinostosis son escasos, hasta ahora estos datos solamente han sido evaluados retrospectivamente. El propósito de este estudio, es el seguimiento prospectivo de aquellos niños sometidos a cirugía por craneosinostosis, enfocándose específicamente en complicaciones relacionadas con el uso de los materiales aplicando OAURC.

Diez pacientes pediátricos (3 femeninos/7 masculinos) fueron operados utilizando OAURC (SonicWeld/ Resorb-X, KLS Martin, Tuttlingen, Alemania) debido a craneosinostosis; la edad promedio de esos pacientes fue de 9.1±3.8 meses. Se llevaron a cabo examinaciones clínicas de seguimiento 1, 3, 6, 9, 12 y 18 meses después de la cirugía buscando señas de infección local, estabilidad de la bóveda craneoencefálica y palpando la zona con osteosíntesis. En caso de que se requiriera una segunda operación quirúrgica, la indicación para ella se documentaba y se evaluaba por medio de exámenes histológicos y con laminillas citológicas de la herida.

No hubo complicaciones intra - ni post operatorias durante el periodo de hospitalización. Tres pacientes necesitaron una segunda operación debido a una inflamación localizada en el área de la incisión quirúrgica, la cual se llevó a cabo 3, 9 y 12 meses después de la primera operación. En todos estos casos, los exámenes histológicos demostraron formación de granulomas con células gigantes rodeando el material reabsorbible. Además, en un caso, las laminillas citológicas obtenidas de la herida demostraron una infección por bacterias.

Este estudio prospectivo es el primero en el uso de este procedimiento. Revela un porcentaje alto de reacción inflamatoria granulomatosa por cuerpo extraño con OAURC, llevando a la necesidad de proceder con una segunda operación quirúrgica.

Sale que el alto porcentaje de complicaciones encontradas en este estudio prospectivo puede sobre pesar las ventajas que ofrece OAURC y que por lo tanto, el uso clínico de esta técnica, no sea recomendable hasta que haya más datos prospectivos utilizando una población con un número mayor de pacientes que demuestren un resultado más favorable.

Palabras clave:
Cirugía craneofacial
Craneosinostosis
Materiales reabsorbibles
Osteosíntesis activada por ultrasonido en clavos reabsorbibles
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Nkenke, E.; Vairaktaris, E.; Schwarz, S.; Eyüpoglu, I.; Ganslandt, O.; Leis, T.; Knipfer, C.; Stelzle, F.: Prospective assessment of complications associated with ultrasound activated resorbable pin osteosynthesis in pediatric craniofacial surgery: preliminary results. Neurocirugía 2011; 22: 495–506.

Copyright © 2011. Sociedad Española de Neurocirugía
Neurocirugía (English edition)

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