Use of absorbable poly (D,L) lactic acid plates in cranial-vault remodeling: Presentation of the first case and lessons learned about its use

Objective: To present the first clinical use of a new bioabsorbable material, poly (D,L) lactic acid (PDLLA), in pediatric cranial-vault remodeling procedures. This discussion will highlight the benefits and detriments of PDLLA in comparison with currently used absorbable plating systems. Design: This was a case study documenting the first North American case in which PDLLA was used to treat craniosynostosis. Materials and Methods: Evaluation of pure PDLLA, a copolymer product of the mixture of poly L-lactic acid and its D-isomer, was used in an 8-month-old boy with a severe phenotypic expression of sagittal craniosynostosis. No signs of elevated intracranial pressure were present, and the neurological examination did not show impairments. Total cranial-vault remodeling with the "hung-span" technique was performed. The Resorb X system, containing 2.2 mm screws and 0.6- to 1-mm-thick plates, was used to stabilize the reconstructed cranial vault. Results: No surgical complications occurred. The preoperative cranial index measured 62. The scaphocephalic appearance of the skull was eliminated, and the cranial index was normalized to 77. The screws and plates were less palpable than other plating systems. Twelve months postoperatively, none of the plates and screws were identifiable by external palpation. Conclusion: Resorb X has been successfully used in the treatment of sagittal craniosynostosis. Its rapid rate of resorption and lower profile make it an advantageous system for pediatric skull reconstruction. This represents the first use of this product in the United States for any pathology.