Complications of Polydioxanone Foil Use in Nasal Surgery: A Case Series

Abstract

Polydioxanone (PDS) foil is widely recognized as a septal cartilage replacement during rhinoplasties and is thought to be completely resorbable and biodegradable. Since its United States Food and Drug Administration approval in 2010, PDS foil has drawn significant enthusiasm and many surgeons consider it an ideal implantable biomaterial as reflected in numerous studies highlighting its benefits. However, scant literature exists highlighting relevant complications of PDS plates that may potentially lead to cavalier overuse. This descriptive case series assesses the outcomes of PDS foil usage in three patients seen for septoplasty at two independent institutions over the past 5 years. Our results demonstrate that PDS plate usage can lead to septal cartilage loss and resultant saddle nose deformıty associated with prolonged postoperative edema and inflammation. To our knowledge, this is the largest case series of this reported phenomenon.

Keywords

rhinoplasty - septoplasty - polydioxanone - biomaterials - nasal surgery

• References

• 1 Hassan HM, Mohamed SK, Alherabi AZ. Combining polydioxanone plate, conchal cartilage interpositional graft and rotation flaps for repair of septal perforation. Egypt J Ear Nose Throat Allied Sci 2015; 16 (03) 217-221
• 2 Bussi M, Palonta F, Toma S. Grafting in revision rhinoplasty. Acta Otorhinolaryngol Ital 2013; 33 (03) 183-189
• 3 Boenisch M, Mink A. Septal reconstruction with a polydioxanone plate (PDS). FACE Facial Aesthetic Commun Eur 1999; 6: 149-154
• 4 Boenisch M, Mink A. Clinical and histological results of septoplasty with a resorbable implant. Arch Otolaryngol Head Neck Surg 2000; 126 (11) 1373-1377
• 5 Boenisch M, Tamás H, Nolst Trenité GJ. Influence of polydioxanone foil on growing septal cartilage after surgery in an animal model: new aspects of cartilage healing and regeneration (preliminary results). Arch Facial Plast Surg 2003; 5 (04) 316-319
• 6 Rimmer J, Saleh H. Use of polydioxanone plate in septal reconstruction. Facial Plast Surg 2013; 29 (06) 464-472
• 7 Kim JH, Wong B. Analysis of cartilage-polydioxanone foil composite grafts. Facial Plast Surg 2013; 29 (06) 502-505
• 8 Fuller JC, Levesque PA, Lindsay RW. Polydioxanone plates are safe and effective for L-strut support in functional septorhinoplasty. Laryngoscope 2017; 127 (12) 2725-2730
• 9 Dayan SH, Ashourian N. Polydioxanone absorbable plate for cartilaginous grafting in endonasal rhinoplasty: a randomized clinical trial. JAMA Facial Plast Surg 2016; 18 (01) 47-53
• 10 Tweedie DJ, Lo S, Rowe-Jones JM. Reconstruction of the nasal septum using perforated and unperforated polydioxanone foil. Arch Facial Plast Surg 2010; 12 (02) 106-113
• 11 Caughlin BP, Been MJ, Rashan AR, Toriumi DM. The effect of polydioxanone absorbable plates in septorhinoplasty for stabilizing caudal septal extension grafts. JAMA Facial Plast Surg 2015; 17 (02) 120-125
• 12 Sabino MA, González S, Márquez L, Feijoo JL. Study of the hydrolytic degradation of polydioxanone PPDX. Polym Degrad Stabil 2000; 69 (02) 209-216
• 13 Ping Ooi C, Cameron RE. The hydrolytic degradation of polydioxanone (PDSII) sutures. Part I: Morphological aspects. J Biomed Mater Res 2002; 63 (03) 280-290
• 14 Cameron AE, Parker CJ, Field ES, Gray RC, Wyatt AP. A randomised comparison of polydioxanone (PDS) and polypropylene (Prolene) for abdominal wound closure. Ann R Coll Surg Engl 1987; 69 (03) 113-115
• 15 Rimmer J, Ferguson LM, Saleh HA. Versatile applications of the polydioxanone plate in rhinoplasty and septal surgery. Arch Facial Plast Surg 2012; 14 (05) 323-330
• 16 Gristina AG, Naylor P, Myrvik Q. Infections from biomaterials and implants: a race for the surface. Med Prog Technol 1988- 1989; 14 (3-4): 205-224
• 17 Hollinger JO, Battistone GC. Biodegradable bone repair materials. Synthetic polymers and ceramics. Clin Orthop Relat Res 1986; (207) 290-305