Aisawa Mizuna, Kubota Yoshitaka, Azuma Kazuhiko, Ohki Syota, Ishii Kentaro, Yamaji Yoshihisa, Akita Shinsuke, Ikehara Yuzuru, Mitsukawa Nobuyuki
From the Department of Plastic, Reconstructive, and Aesthetic Surgery, School of Medicine, Chiba University, Chiba, Japan.
Department of Pathology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Plast Reconstr Surg Glob Open. 2025 Mar 10;13(3):e6611. doi: 10.1097/GOX.0000000000006611. eCollection 2025 Mar.
Absorbable bone fixation materials are commonly used in facial bone fracture surgery. However, reports on the microstructure of infected implants are rare. This study presents a case involving a 74-year-old male patient who developed an α- infection 2.5 months after zygomatic bone fracture surgery and the ultrastructure of an infected absorbable plate observed under a scanning electron microscope (SEM). The patient sustained a right zygomatic bone fracture due to a fall and underwent open reduction and internal fixation with SonicWeld on the seventh day after the injury. The postoperative course was uneventful, but 2.5 months after the surgery, the patient presented with redness, swelling, and pain in the right lower eyelid, along with purulent discharge, leading to the removal of the bone fixation material. The SEM observation of the extracted implant revealed a biphasic pattern, with areas showing signs of infection and areas without such effects. The infected regions showed wide cracks, bacterial clusters, and biofilm formation, whereas noninfected areas exhibited narrow cracks and distinct geometric striations. These findings suggest a link between crack formation and bacterial proliferation, emphasizing the importance of proper handling and implantation techniques. Although the infection was controlled and bone healing achieved after the removal of infected implants, the patient experienced lower eyelid retraction due to adhesion between the skin and underlying bone, leading to persistent cosmetic issues. This case report presents a rare visualization of the ultrastructural characteristics of infected absorbable implants, offering insights into the potential role of SEM in understanding these changes and processes.
可吸收骨固定材料常用于面部骨折手术。然而，关于感染植入物微观结构的报道却很少。本研究报告了一例病例，一名74岁男性患者在颧骨骨折手术后2.5个月发生α感染，并在扫描电子显微镜（SEM）下观察了感染的可吸收接骨板的超微结构。该患者因跌倒导致右侧颧骨骨折，受伤后第7天接受了切开复位并用索诺威德（SonicWeld）进行内固定。术后过程顺利，但术后2.5个月，患者出现右下眼睑红肿、疼痛，并伴有脓性分泌物，导致骨固定材料被取出。对取出的植入物进行SEM观察发现呈现双相模式，有感染迹象的区域和无此影响的区域并存。感染区域出现宽裂缝、细菌团簇和生物膜形成，而未感染区域则呈现窄裂缝和明显的几何条纹。这些发现表明裂缝形成与细菌增殖之间存在联系，强调了正确处理和植入技术的重要性。尽管在取出感染的植入物后感染得到控制且实现了骨愈合，但患者因皮肤与下方骨骼之间的粘连而出现下眼睑退缩，导致持续存在美容问题。本病例报告展示了感染的可吸收植入物超微结构特征的罕见可视化情况，为SEM在理解这些变化和过程中的潜在作用提供了见解。
