Special Topic Developments in Craniomaxillofacial Surgery: Use of Self-Reinforced Bioabsorbable Osteofixation Devices Nureddin Ashammakhi, M.B.B.Ch., F.R.C.S.(Ed.), Ph.D., Hilkka Peltoniemi, M.D., Ph.D., Eero Waris, Riitta Suuronen, M.D., D.D.S., Ph.D., Willy Serlo, M.D., Ph.D., Minna Kellomäki, M.Sci.(Eng.), Pertti Törmälä, Ph.D., B.M.S., and Timo Waris, M.D., Ph.D. Oulu, Helsinki, and Tampere, Finland Because of the problems associated with the conven- tional osteofixation devices used in craniomaxillofacial surgery, absorbable devices present an appealing alterna- tive. Devices made of the polymers polylactide, polygly- colide, and their copolymers (PLGA and P[L/DL]LA) are currently the most commonly used. Ultrahigh-strength implants can be manufactured from these polymers with the self-reinforcing technique. Over the authors’ almost two decades of study, both in experimental and clinical settings, self-reinforced devices have proved to be bio- compatible, easy to handle, and mechanically strong, even for the fixation of femoral neck fractures. In craniomax- illofacial surgery, the authors have used self-reinforced devices for over 8 years without complications. Because of the more favored degradation characteristics, currently the copolymeric self-reinforced devices (P[L/DL]LA, Bio- sorb FX and PLGA, Biosorb PDX; Elite Performance Technologies, Solana Beach, Calif.) represent the advanc- ing front in the application of absorbable devices in crani- omaxillofacial surgery. The authors’ share their experi- ence and their studies of self-reinforced devices, which possess the highest strength and ductility of all bioabsorb- able products. (Plast. Reconstr. Surg. 108: 167, 2001.) Because of the risks, limitations, and prob- lems associated with metallic implants, 1–20 es- pecially in pediatric craniofacial surgery, 7,15,18 absorbable devices have been developed. Among the various absorbable polymers, the polyesters polylactide, polyglycolide, and their copolymers (P[L/DL]LA and PLGA) are the most important because of their bio- compatibility, adjustable mechanical proper- ties, adjustable degradation rates, and resorbability through biologic processes. 21–24 Devices comprise plates, screws, and pins that can be used for fixation of craniomaxil- lofacial osteotomies and fractures, and fab- rics, meshes, plates, and mesh-plates that are used for tissue engineering. The self-reinforcement technique uses the solid-state deformation of a polymer material to yield a composite in which matrix and rein- forcing elements are of the same polymer. 22,23 Self-reinforced devices are superior in terms of mechanical strength and handling proper- ties. 22–24 These devices are the subject of a large body of literature, 25– 85 patenting, 23 and doc- toral dissertations. 86 –100 Results obtained from our experimental studies using these implants in craniomaxillofacial surgery have been en- couraging, 25,26,54,59 – 63,69 –73,78,99,101,102 and we have used these devices in clinical craniomaxillofa- cial settings 51–53,80,85,103–105 without long-term problems. 75,103 Self-reinforcing devices have also been accepted by craniomaxillofacial sur- geons in other countries 44 – 47,80,83– 85,106,107 with successful results. It has been possible to de- velop new surgical techniques, such as en- docranial 104 or intraosseous 60 applications, in craniofacial surgery that would be impossible using the conventional metallic devices. In this article we review issues related to the development, experience, and applications of absorbable polylactide, polyglycolide, and their copolymeric devices, with a special focus on self-reinforced devices in craniomaxillofacial surgery. From the Division of Plastic Surgery, Department of Surgery, and the Department of Pediatrics, Oulu University Hospital, the Departments of Plastic Surgery and Oral and Maxillofacial Surgery, Helsinki University Central Hospital, and the Institute of Biomaterials, Tampere University of Technology. Received for publication December 14, 1999; revised November 28, 2000. 167