Combined use of bio-absorbable polymer system with titanium plate in revascularization surgery for moyamoya disease

Abstract

Moyamoya disease is a chronic occlusive cerebrovascular disease with unknown etiology that is common in children and young adults with a female predominance. Wound trouble is a potential complication of revascularization surgery for moyamoya disease, while the optimal procedure of the cranioplasty and skin closure is undetermined. To minimize the postoperative physical stress to the typically thin scalp with poorer blood supply found in most moyamoya patients, we used a bio-absorbable polymer system (80% poly-L lactic acid and 18% poly-glycolic acid; LactoSorb®) adjacent to the incision in combination with a titanium plate for cranium fixation in 48 surgeries for 43 patients aged from 10 to 62 years (mean 38.9). There was no wound trouble during the mean follow-up period of 13.8 months. None of the 43 patients suffered from wound infection, subcutaneous cerebrospinal fluid collection, nor the delayed wound healing that frequently affects a patient’s admission schedule. There was no adverse effect from the bio-absorbable polymer system itself including delayed inflammation around the site of fixation. Combined use of a bio-absorbable polymer system with a titanium plate is a safe and effective procedure for treating moyamoya disease that can also avoid surgical complications on the scalp.