This document provides an overview of implant usage in surgery. It defines an implant as a surgically inserted foreign material used to replace, support, or enhance a biological structure. The document then discusses implant classification, materials, indications, principles of usage, complications, emerging trends, and concludes that implants are invaluable for surgical therapy but not without risks, and an ideal implant has yet to be discovered.

1. USE OF IMPLANT IN SURGERY
DR BASHIR YUNUSA
SURGERY RESIDENT AKTH
26/01/16

2. OUTLINE
• INTRODUCTION
• CLASSIFICATION
• PRINCIPLES OF USAGE
• COMPLICATIONS
• USES OF IMPLANTS
• EMERGING TRENDS
• CONCLUSION
• REFERENCES

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. 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. 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. 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. 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. 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. CALCIUM CERAMICS
• Hydroxyl apartite
• Tricalcium phosphate
• Tetra calcium cement (hydroxylapatite cement)

10. BIODEGRADABLE MATERIALS
• Collagen
• fibrel

11. POLYMERS
• Silicone
• Polyurethrane
• Polymethyl metacrylate
• Polyester (Dacron, mersilene)
• Poly ethylene
• Polypropylene
• Cyanoacrylate
• Polytetrafluroethylene PTFE

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. • 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. Post-op
• Wound
• X-ray
• Follow
• Complications
• Failure

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. USES OF IMPLANT
ORTHOPAEDIC SURGERY
• Nails
• Wires
• Screws
• Plates and screws
• Bone cements
• Joint prosthesis

17. Plates

18. screw
• Cortical
• Cancellous
• Locking

19. Kirschner’s wire

20. NAILS
• Intramedullary nails

21. JOINT REPLACEMENT

22. GENERAL SURGERY
• Polypropylene mesh implants in hernia repairs
• Palliative stents of malignant obstructive lesions (endoluminal
prosthesis)
• Bile duct drainage (latex T-tube)

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.

26. 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

28. PACEMAKER

29. UROLOGY
• Ureteric stent
• Urethral stents
• Penile implants using inflatable silastic tubes in mgt of ED
• Penile enlargement implants
• Testicular implants

30. Ureteric stent

31. Penile implant

32. NEUROSURGERY
• Ventricular shunts using silastic tubes in hydrocephalus
• Excimer laser non occlusive anastomosis (ELANA) in cerebral vascular
bypass using laser catheter.

34. 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

35. Cochlear implants

36. OPHTHALMOLOGY
• Glaucoma drainage device made from silicone (silicone tube and
plate)
• Lens implants
• Globe implants

37. Dental surgery
Endo-osteal
Subperiosteal
Transosteal
Intramucosal

38. 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

39. 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

40. 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

41. EMERGING TREND
• Biodegradable fixation
• Minimally invasive
• Saline filled breast implants
• Implants incorporated into bone growth

42. 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.

43. 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

44. • Thank you for listening