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Use of implant in surgery


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Use of implant in surgery

  3. 3. INTRODUCTION • An implant is a surgically inserted foreign material or device to replace a biological missing structure, support damage structure or enhance an existing structure. • An implant is a foreign material or device that is inserted, embeded or fixed into a living tissue for functional or cosmetic reasons.
  4. 4. EPIDEMIOLOGY • Use of implant is on the rise world wide attributed to cosmetic augmentations, rising disease incidence and reduce the need for transplant. Estimated 20-25million US patients have had a medical device implanted. • In African sub-regions due to development of specialties.
  5. 5. QUALITY OF AN IDEAL IMPLANT An ideal implant should: • Not cause inflammatory or foreign body response • Non-allergenic • Non-carcinogenic • Resistant to strain • Fabricated into desired form • Sterilizable • Radio-opaque • Non yet to be found
  6. 6. INDICATIONS • Reconstruction e.g breast reconstruction after mastectomy, • Augmentation e.g breast augmentation mammoplasty, dental implant bone augmentation. • Fixation & stabilization e.g fractures, dentures • Replacement e.g missing structure, deformed or painful joint.
  7. 7. CLASSIFICATION • US classification The US Food and Drug Administration(FDA) classify medical devices base on the risk to the user • Class 1- least amount of risk, rquires least amount of control e.g arm sling, hand held surgical instrument • Class 2- need more regulation than class 1. are required to undergo specific requirement before FDA approval. E.g X-rays, monitors • Class 3- requires most regulatory control, since device sustain or support life – medical implants • Temporary or permanent • Soft or hard • Biodegradable & nonbiodegradable • Synthetic or biological • Base on the chemical properties of the implant; metals, calcium ceramics, biodegradable, polymers
  8. 8. BASE ON THE CHEMICAL PROPERTIES OF IMPLANT • METALS • Are used mainly in orthopedics, craniomaxillofacial and hand surgeries. Eg Kirschner wires, cranial plates, artificial joints. • Currently used metals; • Titanium, stainless steel, valium,gold. • Properties; biocompatible, strength, resistance to corrossives, radio- opaque. • Titanium is light weight 6 times stronger than compact bone, modulus of elasticity is 5 times greater than compact bone. Most commonly used is commercially pure titanium or titanium-aluminuim-vanadium
  9. 9. CALCIUM CERAMICS • Hydroxyl apartite • Tricalcium phosphate • Tetra calcium cement (hydroxylapatite cement)
  10. 10. BIODEGRADABLE MATERIALS • Collagen • fibrel
  11. 11. POLYMERS • Silicone • Polyurethrane • Polymethyl metacrylate • Polyester (Dacron, mersilene) • Poly ethylene • Polypropylene • Cyanoacrylate • Polytetrafluroethylene PTFE
  12. 12. PRINCIPLES • PRE-OPERATIVE • Patient must meet indications • Perioperative prep & mgt – All physiological derangement is corrected • Informed consent • Selection • Depends on the specific requirement for its use • Site & strength of the tissue • Appropriate size • Availability • Affordability • Expertise
  13. 13. • INTRA-OP • Adequate anaethesia • Strict aseptic techniques • Antibiotic prophylaxis • Adequate incision • Adequate soft tissue cover • Must be accessible for removal if necessary • For injectable one should be cautious not to inject in vessels • Implant be of appropriate size and shape to avoid sharp curves and edges
  14. 14. Post-op • Wound • X-ray • Follow • Complications • Failure
  15. 15. COMPLICATIONS • Local • FAILURE – inadequate for function expected. or failure to produce a satisfactory result • • Causes of such failure can be grouped into four categories: • surgical • material; Fatigue failure, Corrosion, Implant wear, Loosening, Breakage • Idiosyncratic • patient compliance • Extrusion • Infection • Tissue reaction • migration • Hematoma • Seroma • Systemic • Allergies • Carcinogenesis
  16. 16. USES OF IMPLANT ORTHOPAEDIC SURGERY • Nails • Wires • Screws • Plates and screws • Bone cements • Joint prosthesis
  17. 17. Plates
  18. 18. screw • Cortical • Cancellous • Locking
  19. 19. Kirschner’s wire
  20. 20. NAILS • Intramedullary nails
  22. 22. GENERAL SURGERY • Polypropylene mesh implants in hernia repairs • Palliative stents of malignant obstructive lesions (endoluminal prosthesis) • Bile duct drainage (latex T-tube)
  23. 23. PLASTIC SURGERY • Breast implants using silicone • Malar and submalar implants using subcut materials like ePTFE • Body contouring like buttock enhancement using silicone • Use of gold as upper eyelid weight.
  24. 24. CARDIOVASCULAR SURGERY • Heart valve replacement • Drug eluting biodegradable coated stents in coronary vascular disease • Pacemakers • Septal defect repair using nylon patches • Vascular stents using ePTFE in aneurysm repairs
  25. 25. PACEMAKER
  26. 26. UROLOGY • Ureteric stent • Urethral stents • Penile implants using inflatable silastic tubes in mgt of ED • Penile enlargement implants • Testicular implants
  27. 27. Ureteric stent
  28. 28. Penile implant
  29. 29. NEUROSURGERY • Ventricular shunts using silastic tubes in hydrocephalus • Excimer laser non occlusive anastomosis (ELANA) in cerebral vascular bypass using laser catheter.
  30. 30. ENT SURGERY • Nasal reconstruction using silicone, tricalcium phosphate cements • Palatal implants using inserts (made from silicone, polyester ) in soft palate in surgical management of snoring and obstructive sleep apnoea • Cochlear implants in sensorineural deafness
  31. 31. Cochlear implants
  32. 32. OPHTHALMOLOGY • Glaucoma drainage device made from silicone (silicone tube and plate) • Lens implants • Globe implants
  33. 33. Dental surgery Endo-osteal Subperiosteal Transosteal Intramucosal
  34. 34. MESH • Synthetic • High tensile strength • Unsuitable for intraperitoneal placement • Tissue reaction, stiffness, fibrosis • E.g polypropylene, PTFE, ePTFE, polysters. • Biological • Collagen base- human or porcine • use intra or extra-peritoneal • Can be used to contaminated or infected surgical field • Overcome the problems of chronic inflammation and foreign body reaction, stiffness and fibrosis associated synthetic mesh. • Composite • Dual coated,- visceral and parietal side. Visceral side repels tissue ingrowth and decrease adhesion. Synthetic parietal side promotes strong repair • Microporous <10um • Allows bacteria but prevent macrophage passage, cannot clear infection • Granuloma more likely to form leading to stiffness of scar. • Multifilament • Macroporous > 75um • Allow infiltration by macrophage, blood vessels, fibroblast and collagen • More flexible becomes of avoidance of granuloma. • monofilament
  35. 35. BREAST IMPLANT • Subcutaneous, subglandular, submuscular • Implant in submuscular plane is better whenever muscle is not removed during surgery.(better soft tissue covering and hide irregular contour) • If muscle is removed as in radical mastectomy, then subcutaneous implant is placed. • Silicon gel implants • Saline implant • complications • Pain, exposure of implant and rupture • Displacement, extrusion • Infection • Capsular contraction • Rippling
  36. 36. HEART VALVES • Mechanical; manufatuerd from varieties of materials like alloys, silicon, rubber etc. donot resemble native valve. Risk of thrombo- embolism. Requires anticoagulant. • Tilting disc valves • Bileaflet valve • Biological; they are made from human or animal tissue. Have good hemodynamic performance, the thromboembolic risk is small. Can be used without anticoagulant. But short lived(5-10years), hence requires 2nd operation. Especially in young patient • Allograft • Glutaraldehyde-treated porcine(pig) valves • Glutaraldehyde-treated pericardial valves • Choice of valve
  37. 37. EMERGING TREND • Biodegradable fixation • Minimally invasive • Saline filled breast implants • Implants incorporated into bone growth
  38. 38. CONCLUSION Implants are invaluable in surgical therapy especially in replacing damage body part. Availability, affordability, and expertise is paramount for a successful therapy. They are not without side-effects. The world still awaits emergence of an ideal implant.
  39. 39. REFERENCES • M.A.R.Al-Fallouji:Postgraduate surgery,2nd Edition. • Apley’s system of orthopaedics Eight Edition • Bailey and Love’s “Short Practice of Surgery” 26th edition CRC press Taylor and Francis group. 2013 • E.A Badoe et al, “Principles and Practice of surgery including pathology in the tropics” 4th edition, Assembly of God Literature Center ltd, 2009 • A.S .Breitbart & V.J.Ablaza:Dept of plastic & Reconstructive surgery,New York University Medical Center. • Deporah, Shatin, et al; “Data base for studying the epidemiology of implanted medical devices” The Bionic Human pp115-132 • Van Eck, Chen AF et al; “the classification of implants” J long term Eff Med Implant 2009; 19(3) 185-93
  40. 40. • Thank you for listening