Immediate and long-term results of unsintered hydroxyapatite and poly L-lactide composite sheets for orbital wall fracture reconstruction

Publication date: Available online 28 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Keishi Kohyama, Yoko Morishima, Koki Arisawa, Yuko Arisawa, Hisakazu Kato
IntroductionBone defect reconstruction in orbital wall fractures with absorbable alloplastic, such as unsintered hydroxyapatite and poly L-lactide composite (u-HA/PLLA), is gaining popularity. This material is osteoconductive and osteosynthetic. However, quantitative, long-term outcome data after use for orbital wall fractures are lacking.Patients and MethodsWe retrospectively analyzed 115 patients who underwent surgical repair of orbital wall fractures with a u-HA/PLLA sheet from 2011 to 2016. A chart review was performed, and the time-dependent changes at fracture sites were assessed via imaging. The immediate postoperative and the latest follow-up bony orbital volumes of the affected side were compared.ResultsThere were 70 eligible patients in this study (mean age, 44.6 ± 22.1 years; 48 men and 22 women; mean follow-up period, 29.7 ± 12.8 months). Except for one case of hematoma, there were no postoperative wound complications. Although 10/70 patients had postoperative diplopia and 2/70 had enophthalmos, they were presumably caused by the extension and severity of the fracture. Satisfactory reduction of the entire orbital wall, without pathological changes, was demonstrated. There were no significant differences in the mean bony orbital volumes of the affected side immediately after surgery (24.774 ± 3.092 cm³⁾, and at the latest follow-up (24.749 ± 3.205 cm³⁾ (p=0.756).ConclusionThe u-HA/PLLA sheet is useful for orbital wall fracture reconstruction because of its desirable handling characteristics, initial mechanical strength, long-term maintenance of structural stability, radiopacity, and few associated complications. Future randomised controlled trials to compare u-HA/PLLA with other conventional materials need to be performed.