I found a website that uses Avitene tissue clay to augment bone or soft tissue. Why have I never come across this before, is it not used anymore?
Tissue Clay for Use in Plastic Surgeries?
Doctor Answers 2
Tissue clay or cement
There are many different bone cement type substitutes. These tend to fall into the hydroxyapatite group or the methylmetacrylalte group. Hydroxyapatite tends to be incorporated to some degree..
Avitene tissue clay to augment bone or soft tissue
I have only been able to find one doctor who uses this primarily in revision rhinoplasty surgery. I do not know how long after surgery the follow up photos were taken. It is a mixture of avitene presumably powder with the patient's own blood to form a putty that is placed on top of bone for bone augmentation.
Avitene comes in a light flour form and a non-woven web form that looks like cloth. This is collagen, which is derived from cow skin. It binds tightly to blood surfaces, so you do not actually need to achieve a relatively dry field in order to apply it to stop bleeding (its primary use). It causes contact activation of blood clotting and directly activates platelets. It is absorbed in three months and it needs to be applied dry to clot blood. Using it as a clay is basically using a clot of the patient's own blood for augmentation. The main question is how long will this last as even a bruise which is blood outside the blood vessel but under the skin eventually goes away. A clot under the skin is basically a thicker bruise.
Avitene causes a certain amount of foreign body reaction and granulation formation especially in its flour form. In fact, the manufacturers recommend that doctors apply these agents, then hold pressure and wait a while for a clot to form and then remove the Avitene afterwards so that you do not leave it within the cavity in order to try to prevent foreign body reaction as much as possible. Mixing it with blood outside the body before applying it may relieve some of these problems but that is unknown to me. On the FDA website there is one report of a nerve problem due to swelling and another of an abscess after application of the flour form.
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