Biochemical characterization of connective tissue reaction to synthetic polymer implants

Potential of Bacterial Cellulose in Reconstructive Surgery of Body Integumentary System: Preliminary Studies in Animals

The aim of the study is to present the preliminary results of the in vivo application of Komagataeibacter xylinum E25 bacterial cellulose (BC) as a replacement material for produced defects during operations. Three pigs (sus scrofa domestica) had the same defects in the ear cartilage (4 × 4 cm) and in the rectus abdominis muscle (6 × 10 cm) with BC membranes implanted into them. The time of observation of the condition of the animals was 3 months. Implantation sites did not show clinical signs of complications in the form of inflammation or necrosis. Histologically, a normal scar was produced as a result of the material healing into the host's body. In one case, no residual implant material was found at the site of implantation, and the remodeled scar confirmed healing. No systemic inflammatory reaction was observed in any of the animals. The host organism's reaction to the bacterial cellulose allows us to believe that it meets the expectations as a material that can be widely used in reconstructive surgery. Nevertheless, this requires further research on a larger group and also using other foreign bodies. The next step would be an experiment on a group consisting of people.

Immunocompatibility and non-thrombogenicity of gelatin-based hydrogels

Immunocompatibility and non-thrombogenicity are important requirements for biomedical applications such as vascular grafts. Here, gelatin-based hydrogels formed by reaction of porcine gelatin with increasing amounts of lysine diisocyanate ethyl ester were investigated in vitro in this regard. In addition, potential adverse effects of the hydrogels were determined using the "Hen's egg test on chorioallantoic membrane" (HET-CAM) test and a mouse model.The study revealed that the hydrogels were immunocompatible, since complement activation was absent and a substantial induction of reactive oxygen species generating monocytes and neutrophils could not be observed in whole human blood. The density as well as the activation state of adherent thrombocytes was comparable to medical grade polydimethylsiloxane, which was used as reference material. The HET-CAM test confirmed the compatibility of the hydrogels with vessel functionality since no bleedings, thrombotic events, or vessel destructions were observed. Only for the samples synthesized with the highest LDI amount the number of growing blood vessels in the CAM was comparable to controls and significantly higher than for the softer materials. Implantation into mice showed the absence of adverse or toxic effects in spleen, liver, or kidney, and only a mild lymphocytic activation in the form of a follicular hyperplasia in draining lymph nodes (slightly increased after the implantation of the material prepared with the lowest LDI content). These results imply that candidate materials prepared with mid to high amounts of LDI are suitable for the coating of the blood contacting surface of cardiovascular implants.

Delayed Foreign Body Reaction Caused by Bioabsorbable Plates Used for Maxillofacial Fractures

BACKGROUND

Bioabsorbable plates and screws are commonly used to reduce maxillofacial bones, particularly in pediatric patients because they degrade completely without complications after bone healing. In this study, we encountered eight cases of a delayed foreign body reaction after surgical fixation with bioabsorbable plates and screws.

METHODS

A total of 234 patients with a maxillofacial fracture underwent surgical treatment from March 2006 to October 2013, in which rigid fixation was achieved with the Inion CPS (Inion, Tampere, Finland) plating system in 173 patients and Rapidsorb (Synthes, West Chester, PA, USA) in 61 patients. Their mean age was 35.2 years (range, 15-84 years). Most patients were stabilized with two- or three-point fixation at the frontozygomatic suture, infraorbital rim, and anterior wall of the maxilla.

RESULTS

Complications occurred in eight (3.4%) of 234 patients, including palpable, fixed masses in six patients and focal swelling in two patients. The period from surgical fixation to the onset of symptoms was 9-23 months. Six patients with a mass underwent secondary surgery for mass removal. The masses contained fibrous tissue with a yellow, grainy, cloudy fluid and remnants of an incompletely degraded bioabsorbable plate and screws. Their histological findings demonstrated a foreign body reaction.

CONCLUSIONS

Inadequate degradation of bioabsorbable plates caused a delayed inflammatory foreign body reaction requiring secondary surgery. Therefore, it is prudent to consider the possibility of delayed complications when using bioabsorbable plates and surgeons must conduct longer and closer follow-up observations.

Compressive properties of fibrous repair tissue compared to nucleus and annulus

The wound healing process includes filling the void between implant and tissue edges by collagenous connective repair tissue. This fibrous repair tissue may load share or stabilize implants such as spinal disc replacements. The objective of this study was the biomechanical characterization of human fibrous tissue compared to annulus fibrosus and nucleus pulposus. Human lumbar discs (10 nucleus and annulus) and 10 lumbar deep wound fibrous tissue specimens were sectioned into 12mm diameter×6mm high cylindrical samples. Confined compression testing, after 2h swelling at 0.11MPa, was performed at 5%, 10% and 15% strain over 3.5h. Unconfined dynamic testing (2-0.001Hz) was performed at 5-15% strain. Semi-quantitative histology estimated the proportion of proteoglycan to collagen. Fibrous tissue exhibited a decrease in height during the swelling period whereas annulus and nucleus tissues did not. The aggregate modulus was significantly less for fibrous tissue (p<0.002). Percent stress relaxation was greatest for the fibrous tissue and similar for annulus and nucleus. Dynamic testing found the storage modulus (E') was greater than the loss modulus (E″) for all tissues. Annulus were found to have greater E' and E″ than nucleus, whereas E' and E″ were similar between annulus and fibrous tissue. Fibrous tissue had the greatest increase in both moduli at greater frequencies, but had the lowest hydration and proteoglycan content. Fibrous tissue would not be a substitute for native tissue within the disc space but if adjacent to a disc prosthesis may impart some degree of intersegmental stability during acute loading activities.

Transarticular fixation with a bioabsorptive screw for cervical spondylolisthesis

OBJECTIVE

Patients with cervical instability and intramedullary signal intensity changes on preoperative magnetic resonance imaging scans may benefit from not only cervical decompression but also from fusion surgery. Transarticular screw (TAS) fixation is a useful technique for posterior fixation. We first report treating a patient with cervical spondylosis and instability by cervical laminoplasty with TAS fixation using a bioabsorptive screw.

METHODS

A 66-year-old woman who had undergone surgery for carcinoma of the tongue via the anterior approach experienced cervical myelopathy. Radiologic findings showed severe cervical canal stenosis with myelomalacia and spondylolisthesis at C4/C5 with instability.

RESULTS

We performed laminoplasty of C3 to C7 and TAS fixation of C4/C5 using a bioabsorptive poly-L-lactide screw that contained hydroxyapatite. Her postoperative course was uneventful, and at 1 year after treatment we confirmed C4/C5 fusion.

CONCLUSIONS

Our method has advantages over metal instrumentation. The treated area can be evaluated with the use of magnetic resonance imaging, and the space left after screw absorption is filled by newly formed bone. Because our screw contains hydroxyapatite, it is osteoconductive. This may increase the fusion rate and induce substitution with new bone. To our knowledge this is the first patient treated by cervical posterior TAS fixation via the use of a bioabsorptive screw. Our method is safe and economical and free of the complications elicited by the use of metal parts. TAS fixation with a bioabsorptive screw may be appropriate for one fixation in patients without severe instability.

A Study of the Mass Transport Resistance of Glucose Across Rat Capsular Membranes

The interaction between a polymer or other foreign surface and soft tissue is determined by a variety of materials and tissue factors. After failing to engulf the foreign body, the classical response is to wall it off. First the site is invaded by macrophages and giant cells and then fibrous connective tissue is laid down. This fibrous connective tissue gradually replaces the cellular matrix and forms the capsule. The composition is mostly collagen and mucopolysaccharides with few cells in the mature capsule. It contains 75–80% water.

When the implant surface represents a sensor and the transport of low molecular weight species across the capsule is necessary for meaningful measurement and response time, the mass transport resistance of the capsule may become a critical factor. This study represents an initial attempt to characterize the diffusion of glucose through fibrous capsules grown around silicone elastomer implants in a rat. Specifically, the study was designed to develop techniques to measure mass transport properties of tissue capsules, to use these techniques to determine effective glucose transport properties at two weeks, four weeks, and ten weeks after implant; and, to use these results along with histological examinations to gain an understanding of the factors which influence mass transport.

Experimental study of the tissue reaction caused by the presence of cellulose produced by Acetobacter xylinum in the nasal dorsum of rabbits

Several materials have been proposed for nasal reconstruction. There is no consensus on which is the best. The cellulose blanket produced by bacteria may be a possible cartilaginous addition element to the nose.

AIM

to study tissue reaction to cellulose in the dorsal nose of rabbits.

MATERIALS AND METHODS

22 New Zealand rabbits were used. In 20 a cellulose blanket was implanted in the nasal dorsum and 2 served as controls. They were followed up through a period of three and six months, after which their nostrils and nasal dorsums were removed and histological studies were carried out on them, considering defined parameters of inflammation such as vascular congestion, intensity of the inflammatory process and presence of purulent exudate.

RESULTS

The inflammatory process remained stable, showing its relationship with the surgical procedure and not with the presence of the cellulose blanket. There were no statistical differences in the other parameters.

CONCLUSION

The cellulose blanket produced by Acetobacter xylinum presented good biocompatibility, remained stable during the entire study period, and could be considered a good material for elevating the nasal dorsum.

Avaliação da resposta inflamatória traqueal ao curativo de celulose bacteriana após escarificação cirúrgica em coelhos

Dentre as causas de insucesso nas cirurgias para a estenose traqueal está a formação de tecidos de cicatrização exuberantes. O uso de curativos para evitar esta reação pode ser de grande valia nestes casos. A celulose bacteriana produzida por acetobacter xylinun pode ser útil nestes casos. Não há estudos na região laringotraqueal. OBJETIVO: Avaliar a resposta tecidual subglótica de coelhos após escarificação e colocação de curativo de celulose, comparando com grupo controle. FORMA DE ESTUDO: Experimental MATERIAL E MÉTODOS: Foram estudados 26 coelhos, submetidos a escarificação da região laringotraqueal e tratados com curativo e comparados com controle. Foram estabelecidos 4 tempos de seguimento. Os seguimentos laringotraqueais foram examinados histologicamente e os resultados foram avaliados estaticamente. RESULTADOS: O grupo de estudo evoluiu com o passar do tempo com resultados estatisticamente semelhantes ao do grupo controle, nos parâmetros Congestão vascular, Exsudato purulento, Inflamação aguda, Integridade do epitélio, Proliferação fibrosa e Reação granulomatosa. CONCLUSÃO: Não foram observadas diferenças entre os grupos controle e de estudo quanto aos parâmetros inflamatórios ou cicatriciais. Não houve sinais inflamatórios relacionados ao uso da membrana de celulose que não tivessem ocorrido devido ao traumatismo cirúrgico.

Tracheal inflammatory response to bacterial cellulose dressing after surgical scarification in rabbits

Exuberant scarring tissue formation is among the failure causes of tracheal stenosis surgery. Dressings that could avoid such reaction could be very helpful in these cases. Bacterial cellulose, produced by acetobacter xylinun can be useful in these cases. There are no studies in the laryngotracheal region.

Aim

to assess subglottic tissue response in rabbits after scarification and placement of cellulose dressing, and comparing it to a control group.

Study design

experimental.

Materials and Methods

26 rabbits underwent laryngotracheal scarification, received the dressing and were compared to the control group. We established four follow up periods. Laryngotracheal specimens underwent histological exam and the results were statistically assessed.

Results

the study group had statistically similar results when compared to the control group in the following parameters: vascular congestion, purulent oozing, acute inflammation, epithelial integrity, fibrous proliferation and granulous proliferation.

Conclusion

we did not observe differences between the study and control groups as far as inflammation and scarring are concerned. There were no inflammatory signs associated with the use of the cellulose membrane that did no occur because of surgery.

Biocompatibility issues with modern implants in bone - a review for clinical orthopedics

Skeletal defects may result from traumatic, infectious, congenital or neoplastic processes and are considered to be a challenge for reconstructive surgery. Although the autologous bone graft is still the “gold standard”, there is continuing demand for bone substitutes because of associated disadvantages, such as limited supply and potential donor side morbidity [1]. This is not only true for indications in orthopedic and craniomaxillofacial surgeries, but also in repairing endodontic defects and in dental implantology.

Before clinical use all new bone substitute materials have to be validated for their osseoconductive and - depending on the composition of the material also –inductive ability, as well as for their long-term biocompatibility in bone. Serving this purpose various bone healing models to test osteocompatibility and inflammatory potential of a novel material on one hand and, on the other hand, non-healing osseous defects to assess the healing potential of a bone substitute material have been developed. Sometimes the use of more than one implantation site can be helpful to provide a wide range of information about a new material [2].

Important markers for biocompatibility and inflammatory responses are the cell types appearing after the implantation of foreign material. There, especially the role of foreign body giant cells (FBGC) is discussed controversial in the pertinent literature, such that it is not clear whether their presence marks an incompatibility of the biomaterial, or whether it belongs to a normal degradation behavior of modern, resorbable biomaterials.

This publication is highlighting the different views currently existing about the function of FBGC that appear in response to biomaterials at the implantation sites. A short overview of the general classes of biomaterials, where FBGC may appear as cellular response, is added for clarity, but may not be complete.

Will the hold of solid biodegradable implants be influenced by swelling during the degradation process? An in-vitro study with Meniscus Arrows

Water uptake after implantation of biodegradable devices induces swelling, as mentioned in literature. The hold in bone of solid devices will increase if the swelling is substantial enough. The results of weighing six Meniscus Arrows (MAs) before and after immersion in a sterile phosphate buffered saline solution during different time intervals were compared with the outcome of measurements under a field emission scanning electron microscope of six other MAs, stored under comparable conditions. The data were statistically evaluated with the Wilcoxon's signed rank test. The weight increase of 2.1 mg or 9.16% was statistically significant in the first 2 h following immersion, remaining stable afterwards with an average weight gain of 1.7 mg or 7.18%. The core diameter of the MAs increased to 0.01 mm or 1.01% with time. Although this is statistically significant, it is not expected to have any consequences for the hold. However, a remarkable and statistically significant decrease in the outer inter-barb diameter of 0.15 mm or 8.6% was noted with time. Mechanical testing should reveal the clinical relevance of the results of this study.

Utility of new bioabsorptive screws in cervical anterior fusion

BACKGROUND

The aim of this study is to report our use of new bioabsorbable screws in cervical anterior fusion. These screws need not be removed because they are completely absorbed by resolution in vivo. We describe our method and the new bioabsorbable screws.

METHODS

We used PLLA screws until September 2004 and uncalcined uHA-PLLA screws thereafter. They are completely absorbed by resolution to water and carbon dioxide upon in vivo hydrolysis. The uHA-PLLA screws are x-ray impenetrable, and their uHA content renders them osteoconductive. In cervical anterior fusion, the graft is inserted in the area of deletion resulting from decompression. The screws are inserted in the 4 corners of the vertebral body and graft. In long fusion, they are introduced in the 2 lateral wings of the bone graft on each vertebral body and in the 4 corners. Our method eliminates the need for plates or mesh.

RESULTS

We have used this method in 62 patients and encountered no complications. There were no screw or graft extrusions and no surgery-related infections. The patients were able to walk a few hours after the operation and wore a simple neck collar for a few days.

CONCLUSIONS

This safe and easy method shortens the hospital stay and reduces the risk of graft extrusion and complications associated with the use of nonabsorbable devices.

Should in the treatment of osteochondritis dissecans biodegradable or metallic fixation devices be used? A comparative study in goat knees

Most of the metallic devices have to be removed, treating osteochondritis dissecans lesions. This animal study describes the biological and mechanical behavior of screws and pins, made of commercially available PGA/PLA and PLA96 and metallic screws and pins, used for fragment fixation. A sham operation served as control. A tissue reaction with cavity formation was observed around every PGA/PLA screw, beginning at 12 weeks following insertion, in contrast to once around a PLA96 screw (p < 0.001), once around one of the 16 PGA/PLA pins and never around those, made of PLA96 (no significance). Disintegration of the PGA/PLA devices started 6 weeks following implantation against 34 weeks for the PLA96 implants. The gap between the fragment and the recipient cartilage disappeared only in the sham group. Many fragments of PGA/PLA material were found in the synovia, in contrast with just a few fragments in the PLA96 group, causing a mild cellular reaction. No polymer particles were found in the draining lymph nodes at any interval. In conclusion, the tested biodegradable screws should not be used for fragment fixation in the treatment of osteochondritis dissecans. Either an undesirable tissue reaction can be expected (PGAPLA), or, because of the slow degradation (PLLA), a screw might damage the opposite cartilage during weight bearing. Two biodegradable pins provide a safe rotational stability and should be combined with one metallic screw, providing compression. This screw has to be removed before loading the limb to prevent cartilage wear of the opposite tibia plateau.

Influence of bioresorbable, unsintered hydroxyapatite/poly-L-lactide composite films on spinal cord, nerve roots, and epidural space

The effect of forged unsintered hydroxyapatite/poly-L-lactide (u-HA/PLLA) composite films on spinal cord and nerve roots and its degradation behavior and osteoconductivity in epidural space were compared with those of calcined HA (c-HA)/PLLA and unfilled PLLA films. Partial laminectomy was performed on 20 rabbits, and u-HA/PLLA and PLLA films were implanted in the intervertebral space. Total laminectomy was performed on 30 rabbits to implant u-HA/PLLA, c-HA/PLLA, and PLLA films in both epidural and subcutaneous spaces. For up to 50 weeks, there were no histological changes in the spinal cord or nerve root, and no inflammatory cell infiltration into the epidural space around the films. The rate of decrease in viscosity average molecular weight of both composite films was initially higher than that of PLLA but eventually became lower, although there was no difference in the degradation behavior of the three films in either the epidural or subcutaneous spaces after 50 weeks. Scanning electron microscopic and energy-dispersive X-ray analysis indicated calcium phosphate deposits on the surface of composite films with new bone formation from 4 weeks. The u-HA/PLLA composite film therefore has good biocompatibility, osteoconductivity, and fast primary degradation rate, which may prove compatible with application to spinal surgery.

Cytotoxicity of poly(96L/4D-lactide): the influence of degradation and sterilization

The cytotoxicity of poly(96L/4D-lactide) (PLA96), and of its accumulated degradation products, was investigated following different sterilization methods and pre-determined heat-accelerated degradation intervals. PLA96 samples sterilized by either steam, ethylene oxide, or gamma irradiation were left untreated (S0 samples), or were degraded for 30 h or 60 h (S30 and S60 samples) at 90 degrees C in water. Extracts of the samples and of the remaining degradation fluids (F30 and F60) were prepared. The toxicity of both unfiltered and filtered extracts was analyzed in a cell growth inhibition (CGI) assay and a lactate dehydrogenase (LDH) leakage assay. Physical analysis of the extracted samples and of the degradation fluids also was performed. The S0 extracts demonstrated no significant CGI. The CGI of the S30 extracts ranged from 37 to 78%, whereas the CGI of the S60 extracts ranged from 6 to 33%. The CGI of the F30 extracts ranged from 19 to 38% and the CGI of the F60 extracts was 98 to 123%. The LDH leakage assay only showed a high response to the unfiltered F60 extracts. Neither sterilization nor filtration appeared to influence the cytotoxicity of the extracts. Particle accumulation, however, might affect cell membrane permeability resulting in LDH leakage. The results of this study suggest that the cytotoxicity of PLA96 is related to the pH and possibly the osmolarity of the tested extracts. The pH and osmolarity, in turn, may depend on variations in the amounts of solubilized lactic acid and oligomers. These variations appear to result from degradation stage-dependent differences in crystallinity, molecular weight and molecular weight distribution of the PLA96 samples.

The future of biodegradable osteosyntheses

In the last 3 decades, much progress has been made in the development of biodegradable osteosyntheses. Despite this progress, these materials are still only used in small numbers, and the scope of their application has been limited. The limitations of biodegradable osteosyntheses mainly are related to problems with their mechanical properties and, in particular, biocompatibility. These problems need to be solved so that biodegradable osteosyntheses can perform up to their full potential and thus, eventually, make their general clinical application routine. This paper presents a historical perspective on the development of biodegradable osteosyntheses, discusses the successful developmental achievements and the still-existing problems, and gives a perspective on their future development.

In vivo degradation and biocompatibility study of in vitro pre-degraded as-polymerized polyactide particles

The degradation of high molecular weight as-polymerized poly(L-lactide) (PLLA) is very slow; it takes more than 5.6 yr for total resorption. Moreover, the degradation products of as-polymerized PLLA bone plates, consisting of numerous stable particles of high crystallinity, are related with a subcutaneous swelling in patients 3 yr postoperatively. In order to avoid these complications, polymers were developed that are anticipated to have comparable mechanical properties but a higher degradation rate and do not degrade into highly stable particles that can induce a subcutaneous swelling. On chemical grounds it can be expected that copolymerization of PLLA with 4% D-lactide (PLA96) or by modifying PLLA through cross-linking (CL-PLLA) will lead to less stable particles and a higher degradation rate. To evaluate the long-term suitability of these as-polymerized polymers, the biocompatibility of the degradation products should be studied. Considering the very slow degradation rate of as-polymerized PLLA, in vitro pre-degradation at elevated temperatures was used to shorten the in vivo follow-up periods. In this study, the biocompatibility and degradation of as-polymerized PLLA, PLA96 and CL-PLLA were investigated by implanting pre-degraded particulate materials subcutaneously in rats. Animals were killed after a postoperative period varying from 3 to 80 wk. Light and electron microscopical analysis and quantitative measurements were performed. The histological response of all three pre-degraded materials showed a good similarity with in vivo implanted material. Pre-degraded PLLA induced a mild foreign body reaction and showed a slow degradation rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Biocompatibility study of as-polymerized poly(L-lactide) in rats using a cage implant system

To evaluate the biocompatibility of in vitro predegraded as polymerized poly(L-lactide) (PLLA), a cage implant system was used to investigate white cell and enzyme concentrations with time. The use of a cage permits in a serial fashion a quantitative and qualitative measurement of exudate components formed around an implant. Subcutaneously in rats, caped cages manufactured from stainless-steel mesh were implanted with in vitro predegraded, as-polymerized PLLA, as-polymerized PLLA cylinders, and empty cages serving as controls. In vitro predegradation was used to simulate the degradation products of long-term in vitro degradation. Predegraded PLLA particles were obtained by in vitro hydrolysis at elevated temperatures. The first 7 days of implantation were characterized by an acute inflammatory reaction; the exudate extracted from the cages showed predominantly neutrophils for all types of implants. After day 7, there was a more chronic inflammatory reaction with predominantly macrophages and lymphocytes. There were no significant differences in the total leukocyte concentration or macrophage concentration for any of the cages in the period from 10-21 days. Extracellular enzyme activity also did not show any significant differences among the three types of cages. A possible explanation for the absence of any significant differences could be that the in vitro predegraded particles were sieved before implantation, thus eliminating all small particles (< 70 microns) that are probably mandatory to provoke an increased cellular reaction.

Autoimmune connective tissue disease and connective tissue disease-like illnesses after silicone gel augmentation mammoplasty

Since first reported in 1982, published anecdotal reports have appeared with increasing frequency of patients in whom autoimmune connective tissue diseases developed after mammary augmentation with silicone gel-filled elastomer envelope-type prostheses. Although scleroderma has been reported most often, other diagnoses have included systemic lupus erythematosus, rheumatoid arthritis, Sjögren's syndrome, and mixed connective tissue disease. Other patients have ill-defined connective tissue-like illnesses often referred to as "human adjuvant disease." The occurrence of dermatomyositis and polymyositis after silicone breast implants appears to be infrequent. We report two new cases of dermatomyositis after silicone exposure. In addition, a comprehensive review of the literature pertaining to rheumatic disease and silicone gel augmentation mammoplasty is presented to provide some perspective on this highly complicated and controversial subject.

Foreign body reactions to resorbable poly(L-lactide) bone plates and screws used for the fixation of unstable zygomatic fractures

In a previous article in the Journal of Oral and Maxillofacial Surgery, the initial results of treating 10 patients with solitary, unstable, displaced zygomatic fractures using resorbable poly(L-lactide) (PLLA) plates and screws was reported (Bos et al, 1987). This article describes the long-term results in these patients. Three years postoperatively, four patients returned because they were concerned about an intermittent swelling at the site of implantation. The remaining patients were recalled after the same postoperative period. All patients were examined clinically, and six patients were operated on again for evaluation of the swelling and to investigate the nature of the tissue reaction. The explanted material showed remnants of degraded PLLA surrounded by a dense fibrous capsule. The swelling was classified as a nonspecific foreign body reaction to the degraded PLLA material. Ultrastructural investigation of the degraded material showed an internalization of crystal-like PLLA material in the cytoplasm of various cells.

The ultrastructural architecture of the tissue/hard-tissue replacement interface

This investigation examined the tissue response and interfacial bonding between bone and hard-tissue replacement (HTR) using scanning (SEM) and transmission (TEM) electron microscopy. Twenty adult male Sprague-Dawley rats were anesthetized and a hole (1.0 mm deep by 2.0 mm wide) was drilled in the calvarium. Subsequently, HTR was implanted and the wound closed. The implants and surrounding tissues were removed at 7, 14, 28, and 56 days and prepared for examination by SEM or TEM. Scanning electron microscopic analysis revealed a typical inflammatory response that subsided by day 14. At that time, a fine layer of collagen fibrils (fibrous envelope) was observed covering the polymeric surface. Energy dispersive x-ray analysis (EDXA) showed no sign of mineralization. Ultrastructural analysis demonstrated that the fibrous envelope was bilaminar; it consisted of a relatively undifferentiated cellular layer adjacent to the polymer and an outer fibrous region. Scanning electron microscopic analysis of 28-day implants showed that osteoblasts had migrated onto the outer surface of the fibrous envelope and that calcification had been initiated as judged by EDXA. Electron microscopic examination confirmed previous observations of an undifferentiated cellular layer along the interfacial boundary, but also showed both macrophages and foreign-body giant cells. At 56 days, bone was observed to contact and cover the fibrous envelope surrounding the polymeric bead; however, EDXA showed that the fibrous envelope remained noncalcified. Transmission electron microscopic analysis revealed that the inner cellular layer was beginning to mature, as indicated by the presence of numerous cellular organelles. This maturation was accompanied by an increased incidence of macrophages as well as foreign-body giant cells. Within the time constraints of the experimental design, it is apparent that a bilaminar layer of cells and fibers remains between the HTR and the bone. Additional studies will be necessary, over extended time periods, to determine whether the bilaminar layer remains a constant feature between the HTR and the surrounding bone or whether this region is gradually supplanted by the ingrowing bone.

Poly(L-lactide) implants in repair of defects of the orbital floor: an animal study

Because of the life-long presence of alloplastic, nonresorbable orbital floor implants and the complications of their use mentioned in literature, the use of a resorbable material appears to be preferable in the repair of orbital floor defects. A high-molecular-weight, as-polymerized poly(L-lactide) (PLLA) was used for repair of orbital floor defects of the blowout type in goats. An artificial defect was created in the bony floor of both orbits. Reconstruction of the orbital floor was then carried out using a concave PLLA implant of 0.4-mm thickness. At 3, 6, 12, 19, 26, 52, and 78 weeks postoperatively, one goat was killed. Microscopic examination showed full encapsulation of the implant by connective tissue after 3 weeks. After 6 weeks, resorption and remodeling of the bone at the points of support of the implant could be detected. A differentiation between the sinus and orbital sides of the connective tissue capsule was observed. The orbital side showed a significantly more dense capsule than the antral side, which had a loose appearance. At 19 weeks, a bony plate was progressively being formed, and at 78 weeks, new bone had fully covered the plate on the antral and orbital side. No inflammation or rejection of the PLLA implant was seen.