title: The RIVET: a novel technique involving absorbable fixation for hydroxyapatite osteosynthesis.
abstract: Cranioplasty using custom-made hydroxyapatite (HAP) ceramic implants is a common procedure for the repair of skull defects. The advantages of using HAP are that it is nonmetallic, unlike titanium; biocompatible; and osteoconductive. Furthermore, it can be molded to any complex shape that may be needed. A disadvantage is that titanium screws and plates are in development for its fixation. We developed a technique for implant fixation using bioabsorbable screws and plates, and named this technique RIVET: resorbable immobilization for vacuolar en bloc technique.Before each operation, the implant was customized for the patient in question on the basis of models prepared using computed tomography data. The bioabsorbable plates were attached to the implant by drilling, tapping, and screwing, as shown in the video (http://links.lww.com/SCS/A43). The interior portion of the screw was then melted to flatten it against the internal surface of the implant, forming a rivet to join the plate and HAP implant.We used this technique for cranial reconstruction in 2 patients, with satisfying and functional results. We did not encounter any complications.In conclusion, the technique described here allows surgeons to fix implants and plates together more rigidly, giving a better result than possible with previous methods.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Shido
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Tomoru
authors.initials: T
authors.lastname: Miwa
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ohira
authors.forename: Kazunari
authors.initials: K
authors.lastname: Yoshida
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kishi
mesh_terms: D020341:Absorbable Implants; D000293:Adolescent; D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000737:chemistry / Q000627:therapeutic use*; D001843:Bone Cements / Q000627:therapeutic use; D001860:Bone Plates; D001863:Bone Screws; D018786:Bone Substitutes / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy / Q000295:instrumentation; D017886:Durapatite / Q000627:therapeutic use*; D004867:Equipment Design; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D011100:Polyglycolic Acid / Q000737:chemistry; D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D019651:Plastic Surgery Procedures / Q000295:instrumentation*; D012886:Skull / Q000601:surgery*; D055815:Young Adult
chemical_list: D001672:Biocompatible Materials; D001843:Bone Cements; D018786:Bone Substitutes; D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D011100:Polyglycolic Acid; D019344:Lactic Acid; D017886:Durapatite