Know the material you use

Know the material you use Eur J Plast Surg (2001) 24:158 DOI 10.1007/s002380100264 LETTER T O THE EDIT OR M. F. Meek · P. H. Robinson · R. R. M. Bos Published online: 12 June 2001 © Springer-Verlag 2001 Dear Sir: We recently read the article “Poly-L-lactic acid quenced materials during degradation, originating from plate for covering of small cranial bone holes: an experi- low molecular weight isotactic sequences. Copolymeriza- mental study in rabbits” by Vesala et al. [1]. In their tion of L-lactide with D-lactide, glycolide, ε-caprolactone, discussion the authors mention that tissue reactions to and trimethylene carbonate has yielded noncrystallizable polylactide materials appear to be minimal and say that materials with a broad spectrum of initial properties and in clinical practice polylactide plates could be used. We hydrolytic bulk degradation patterns. would like to take this opportunity to warn surgeons If the authors took these studies into account, we do about using poly-L-lactic acid (PLLA) materials without not understand why they chose a period of 48 weeks knowing the disadvantages of this material. after implantation, and why they did not use electron- PLLA plates and screws were used for unstable microscopic evaluation to look for possible small remnants displaced zygomatic fractures in the recent past [2]. Two of the PLLA. These references should have been included years after implantation there were no clinical signs of because they are very important when considering using an inflammatory or a foreign body reaction. Three years this material in humans. It is our opinion that pure after implantation, however, patients returned because of poly(L-lactide) implants should not be used clinically. In uncomfortable and intermittent swelling at the implanta- view of the hydrolytic stability of crystalline residue tion site [3]. The explanted material showed remnants of noncrystallizable L-lactide copolymers are preferable for degraded PLLA surrounded by a dense capsule. PLLA degradable biomedical devices. material was found in the cytoplasm of macrophages and fibroblasts. Even after almost 5.5 years, these crystalline PLLA particles were still not fully degraded [4]. References The effect of morphology on the hydrolytic degradation behavior of poly(L-lactide) has been studied by Joziasse 1. Vesala AL, Kallioinen MJ, Kaarela OI, Pohjonen T, Tormala PO, Waris TJ (2000) Poly-L-lactic acid plate for covering of small et al. [5], who demonstrated that lamellar crystallites in cranial bone holes: an experimental study in rabbits. Eur J Plast as-polymerized poly(L-lactide) are very stable towards Surg 23:36–38 hydrolysis. The resorption time of high molecular weight 2. Bos RRM, Rozema FR, Boering G, Nijenhuis AJ, Pennings AJ, as-polymerized poly(L-lactide) in vivo was estimated at Verwey AB (1987) Resorbable poly (L-lactide) plates and screws for the fixation of unstable zygomatic fractures. J Oral 40–50 years. Molding and orientation of crystallizable Maxillofac Surg 45:751–753 polylactides have produced compositions with reduced 3. Bergsma JE, Rozema FR, Bos RRM, de Bruijn WC (1993) crystallinity [5]. Some crystallinity develops in these Foreign-body reactions to resorbable poly (L-lactide) bone plates and screws sed for the fixation of unstable zygomatic fractures. J Oral Maxillofac Surg 51:666–670 M.F. Meek ( ) · P.H. Robinson 4. Bergsma JE, de Bruijn WC, Rozema FR, Bos RRM, Boering G Department of Plastic Surgery, University Hospital Groningen, (1995) Late degradation tissue response to poly (L-lactide) Hanzeplein 1, 9700 RB Groningen, The Netherlands bone plates and screws. Biomaterials 16:25–32 R.R.M. Bos 5. Joziasse CAP, Grijpma DW, Bergsma JE, Cordewener FW, Bos Department of Oral and Maxillofacial Surgery, RRM, Pennings AJ (1998) The influence of morphology on the University Hospital Groningen Hanzeplein 1, hydrolytic degradation of as-polymerized and hot-drawn poly 9700 RB Groningen, The Netherlands (L-lactide). Colloid Polymer Sci 276:968–975 European Journal of Plastic Surgery Springer Journals

Know the material you use

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Medicine & Public Health; Plastic Surgery
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