Download SynPOR HD Facial Shape System. For the augmentation or

SynPOR HD Facial Shape System.
For the augmentation or reconstruction
of the craniomaxillofacial skeleton.
Technique Guide
This publication is not intended for
distribution in the USA.
Instruments and implants
approved by the AO Foundation
Table of Contents
Introduction
Surgical Technique
SynPOR HD Facial Shape System
2
Intended Use, Indications and Contraindications
4
Preoperative Considerations
5
Surgical Technique: Chin
6
Surgical Technique: Malar
11
Patient Care
Post-Operative Care
17
Product Information
Implants
18
Instruments
21
SynPOR HD Facial Shape System
24
References
25
Image intensifier control
Warning
This description alone does not provide sufficient background for direct use of
the product. Instruction by a surgeon experienced in handling these instruments is
highly recommended.
Reprocessing, Care and Maintenance of
Synthes Instruments
For general guidelines, function control and dismantling of multi-part instruments,
please contact your local sales representative or refer to:
www.synthes.com/reprocessing
SynPOR HD Facial Shape System
Technique Guide
DePuy Synthes
1
SynPOR HD Facial Shape System.
For the augmentation or reconstruction
of the craniomaxillofacial skeleton.
Introduction
SynPOR HD Facial Shape Implants are designed for augmenting or reconstructing the contours of the craniofacial skeleton. Each implant is designed to minimize the need for intraoperative contouring.
Features
– Registration tabs assist in symmetric and preferred implant
positioning
– Semiflexible material allows the implant to conform to
underlying bone during fixation
– Pre-shaped designs in multiple sizes to meet clinical needs
– Nonabsorbable, biocompatible material
– Porous structure supports fibrovascular ingrowth
– Smooth surface characteristics
– Can be trimmed with a scalpel or high speed burr
SynPOR HD Malar Implants are designed for craniofacial
reconstruction and augmentation of malar deficiencies.
SynPOR HD Malar Implants are designed to enhance the
malar midface and proximal zygomatic arch. Malar implant
design features include:
– Registration tabs located medially and laterally to assist in
positioning the implant
– Pre-shaped design mimics and conforms to the skeleton
while avoiding impingement of the infraorbital nerve
– Two styles (shell and enhancer) are offered in a range of
sizes to address patient needs
Malar implant, left side, viewed from
above
2
DePuy Synthes
SynPOR HD Facial Shape System
Technique Guide
SynPOR HD Chin Implants augment or reconstruct the
contours of the retrusive or hypoplastic chin. SynPOR HD
Chin Implants are designed to enhance the chin profile and
mandibular border. Chin implant design features include:
– Registration tabs on the inferior border to assist in
positioning the implant
– Pre-shaped design mimics and conforms to skeleton while
avoiding impingement of the mental nerve
– Three-part assembly facilitating insertion
– Chin connector: Flexible titanium connector to allow
adjustments for individual fit and implant positioning
– Two styles (round and square) are offered in a range of
sizes to address patient needs
SynPOR HD Facial Shape System
Technique Guide
DePuy Synthes
3
Intended Use, Indications and Contraindications
Intended use
Synthes SynPOR HD Facial Shape Implants are intended for
the augmentation or reconstruction of the craniomaxillofacial
skeleton.
The MatrixMIDFACE screws included in the SynPOR HD Facial
Shape System should be used for fixation of the SynPOR HD
Facial Shape Implants.
Indications
Synthes SynPOR HD Facial Shape Implants are indicated for
the augmentation or reconstruction of the craniomaxillofacial
skeleton.
Specific indications:
– Enhancement of the malar and chin
– Correction of deficiencies of the malar and chin
Contraindications
Synthes SynPOR HD Facial Shape Implants are not intended
for use in:
– The presence of active or latent infections
– Inadequate coverage of healthy, vascularized tissue
– Full load-bearing applications or to lend structural support
to bone
– Systemic disorders and/or limitations in blood supply that
may cause slow healing and increase the possibility of
infection and/or rejection of the implants
– Tissue that has been compromised by cancer therapies
– Any degenerative disease process that would adversely
affect proper placement of the implants
– Procedures in which a non-sterile environment exists,
such as sinuses
4
DePuy Synthes
SynPOR HD Facial Shape System
Technique Guide
Preoperative Considerations
Evaluation and planning
Successful implantation is technique sensitive and requires
careful preoperative planning. Preoperative planning should
include an understanding of the patient’s desires and an
analysis of both the skeleton and the soft tissue envelope.
Radiologic evaluation can also be useful for defining the
patient skeletal dimensions.
Material
SynPOR HD Facial Shape Implants are manufactured from
an inert, nonabsorbable high density polyethylene (HDPE),
which has a long history of use as a surgical implant.1
The implant’s network of open and interconnecting pores,
approximately 50% greater than 100 µm in size, allows
tissue ingrowth and relative host incorporation rather than
host encapsulation observed with smooth-surface implants.2
Handling
SynPOR HD Facial Shape Implants are provided sterile, for
single use.
Warning: Implants must not be resterilized by any method.
Resterilizing implants may compromise the mechanical properties and sterility cannot be assured.
Do not remove SynPOR HD Facial Shape Implants from the
protective packaging until the time of implantation.
Handle the implant with clean, powder-free gloves to prevent contamination.
Warning: Do not place implants on surgical drapes, surgical
clothing or any other material that may contaminate the
implants with lint or other particulate matter. Implants may
be placed in sterile saline to prevent contamination.
Preparation
SynPOR HD Facial Shape Implants are designed to be placed
directly on the recipient bone. Adequate subperiosteal exposure is important to allow visualization of the anatomical
landmarks and proper placement of the implant.
Warning: Proper aseptic technique is recommended to
prevent contamination of the SynPOR HD Facial Shape
Implants when using intraoral incisions.3
SynPOR HD Facial Shape System
Technique Guide
DePuy Synthes
5
Surgical Technique: Chin
1
Approaches
Chin implants can be placed through intraoral or submental
approaches. The area for desired augmentation should be
exposed by subperiosteal dissection.
The subperiosteal pocket created should extend up to one
centimeter beyond the area for augmentation. The large
pocket allows easier insertion of the porous implant to which
soft tissues tend to adhere and provides perspective for accurate implant placement. Exposing the inferior border of the
anterior mandible allows positioning of registration tabs
which aid in the symmetrical placement of the implant.
Warning: Proper aseptic technique is recommended to
prevent contamination of the SynPOR HD Facial Shape
Implants when using intraoral incisions.3
Notes:
– Shaded region indicates area of subperiosteal dissection.
– Identification of the mental nerve lessens the possibility of
implant impingement on this structure.
6
DePuy Synthes
SynPOR HD Facial Shape System
Technique Guide
2
Sizing and shaping
Instrument
03.540.004
Cutting Board
Chin sizer, round
Chin sizer, square
SynPOR HD Facial Shape Implants are available in a variety of
sizes and styles to minimize the need for alteration. However,
implants can be easily trimmed and contoured with a scalpel
(using the cutting board provided) or with a high speed burr
(holding the implant in your hand) to suit the individual
needs of the patient.
Rinse the implant thoroughly in sterile saline to remove any
particle debris after contouring (cutting or burring).
Optional
Sizers are available to help determine the proper implant necessary to achieve the desired facial contour for each patient.
Precaution: The implant positioning instrument is not recommended to be used with the sizers.
Warnings:
– Do not cut or burr the implant in situ.
– When shaping and contouring the implant, sharp edges
should be avoided to minimize trauma to the surrounding
tissue.
– Implants must never be shaped by use of devices that
produce intense heat such as cauteries, heated knives, or
lasers.
– Do not implant sizers as they are not intended to be used
for permanent augmentation.
– Do not re-use sizers if they have been cut, modified, or
damaged. This prevents them from being properly sterilized and accurately representing their respective implant.
– Do not burr the implant directly on the cutting board.
This can lead to damage of the cutting board and debris
contamination of the implant.
– Do not place implants on surgical drapes, surgical clothing
or any other material that may contaminate the implants
with lint or other particulate matter. Implants may be
placed in sterile saline to prevent contamination.
SynPOR HD Facial Shape System
Technique Guide
DePuy Synthes
7
Surgical Technique: Chin
Precautions:
– If the implant is burred, reestablish the open pore structure by shaving the outer surface with a scalpel.
– If the midline of the chin implant is modified, it could
affect the implant’s fit with the chin connector.
Optional: Contouring
SynPOR HD Facial Shape Implants can be contoured by submerging in hot sterile saline (over 70°C/160°F) for several
minutes until the implant softens. Higher temperatures will
improve the ability to contour the implant.
Remove the implants from the hot saline and contour to the
desired shape. If there is too much resistance, return the
implant to the hot saline.
Allow the implant to cool completely to maintain the
achieved shape. Cold, sterile saline can accelerate the cooling process.
Reheat the implant as needed to achieve the final form
desired.
8
DePuy Synthes
SynPOR HD Facial Shape System
Technique Guide
3
1
Implantation
Instrument
03.540.003
Implant Positioning Instrument
The chin implants consist of right and left halves connected
by a chin connector. The three-piece design facilitates implant insertion. It also allows adjustability in implant positioning.
Registration tab
Registration tabs positioned at the inferior border of the
implant assure that the implant is aligned with the inferior
border of the mandible and lessens the possibility of
impingement on the mental nerve. Removal of the tabs
(which can be done easily with a scalpel or burr) allows more
superior positioning of the implant.
2
It may be helpful to mark the midline of the chin with a drill
or marking pen to assist in implant placement. Separate
the chin implant at the medial junction for two-part insertion.
The implant positioning instrument may be used to facilitate
placement of the implant.
Align the lateral aspects of the implant along the inferior
border of the mandible using the registration tab as a guide
(Figure 1).
3
Reconnect the chin implant halves using the chin connector
and determine medial placement (Figure 2). The chin
connector acts as a hinge to allow the implant to conform to
the anatomy and needs of each mandible. As shown in
the illustration, the hinge function allows the inferior border
of the implant to mimic the specific inclination of the inferior
border of any mandible while allowing variability in vertical
positioning of the chin prominence. In most instances, there
will be a gap between the medial aspects of the implant
halves (Figure 3).
Medial gap
SynPOR HD Facial Shape System
Technique Guide
DePuy Synthes
9
Surgical Technique: Chin
4
Stabilization
Instrument
03.540.003
Implant Positioning Instrument
SynPOR HD Facial Shape Implants should be stabilized with
screws. Screw fixation is recommended to achieve the best
anatomical fit and planned reconstruction.
Screw fixation immobilizes the positioned implant and
eliminates any gaps between the inner surface of the implant
and the surface of the facial skeleton. Screws placed in the
central portion of the chin implant should avoid the titanium
connecting bar. Two screws per implant half are recommended.
The implant positioning instrument may be used to immobilize implants during fixation.
Compress the implant to the facial skeleton before drilling
and screw fixation.
Drill with the appropriate drill bit and insert the appropriate
length screw.
Tighten screws sufficiently to eliminate the gaps between the
implant and the facial skeleton as well as to minimize screw
profile. Gaps between the implant and the skeleton will result in an unanticipated increase in projection equivalent to
the size of the gap. This may limit predictability of the augmentation.
10
DePuy Synthes
SynPOR HD Facial Shape System
Precautions:
– Confirm that implant positioning, drill bit length and
screw length allow for adequate clearance of nerves,
tooth roots and other critical structures.
– Drill rate should never exceed 1,800 rpm. Higher rates can
result in thermally generated necrosis of the bone and
an oversized hole to be drilled. The detriments of an oversized hole include reduced pullout force, increased risk
of screws stripping in bone, and/or suboptimal fixation.
Always irrigate during drilling.
– The implant can break or be damaged due to lack of fixation, excessive activity or trauma.
– Before closing all incisions, take care to remove all porous
polyethylene particles from the surgical site.
Technique Guide
Surgical Technique: Malar
1
Approaches
Depending on the surgeon’s preference, malar implants may
be placed through intraoral approaches, eyelid approaches,
or combinations thereof. The area for desired augmentation
should be exposed by subperiosteal dissection.
The subperiosteal pocket should extend up to one centimeter beyond the area for augmentation. The large pocket allows for easier insertion of the porous implants to which soft
tissues tend to adhere and provides perspective for accurate
implant placement. The lateral aspect of the infraorbital rim
and the superior edge of the zygomatic arch should be freed
of soft tissues to allow positioning of the registration tabs.
Warning: Proper aseptic technique is recommended to
prevent contamination of the SynPOR HD Facial Shape
Implants when using intraoral incisions.3
Notes:
– Shaded region indicates area of subperiosteal dissection.
– Identification of the infraorbital nerve lessens the possibility of implant impingement on this structure.
SynPOR HD Facial Shape System
Technique Guide
DePuy Synthes
11
Surgical Technique: Malar
2
Sizing and shaping
Instruments
03.540.004
Cutting Board
03.550.1XX
SynPOR HD Malar Sizers
Malar Enhancer Sizer
SynPOR HD Facial Shape Implants are available in a variety of
sizes and styles to minimize the need for alteration. However,
implants can be easily trimmed and contoured with a scalpel
(using the cutting board provided) or with a high speed
burr (holding the implant in your hand) to suit the individual
needs of the patient.
Rinse the implant thoroughly in sterile saline to remove any
particle debris after contouring (cutting or burring).
Optional
Sizers are available to help determine the proper implant
necessary to achieve the desired facial contour for each
patient.
Precaution: The implant positioning instrument is not recommended to be used with the sizers.
Warnings:
– Do not cut or burr the implant in situ.
– When shaping and contouring the implant, sharp edges
should be avoided to minimize trauma to the surrounding
tissue.
– Implants must never be shaped by use of devices that
produce intense heat such as cauteries, heated knives,
or lasers.
– Do not implant sizers as they are not intended to be used
for permanent augmentation.
– Do not re-use sizers if they have been cut, modified, or
damaged. This prevents them from being properly sterilized and accurately representing their respective implant.
– Do not burr the implant directly on the cutting board.
This can lead to damage of the cutting board and debris
contamination of the implant.
– Do not place implants on surgical drapes, surgical clothing
or any other material that may contaminate the implants
with lint or other particulate matter. Implants may be
placed in sterile saline to prevent contamination.
12
DePuy Synthes
SynPOR HD Facial Shape System
Technique Guide
Malar Shell Sizer
Precaution: If the implant is burred, reestablish the open
pore structure by shaving the outer surface with a scalpel.
Optional: Contouring
SynPOR HD Facial Shape Implants can be contoured by submerging in hot sterile saline (over 70°C/160°F) for several
minutes until the implant softens. Higher temperatures will
improve the ability to contour the implant.
Remove the implants from the hot saline and contour to the
desired shape. If there is too much resistance, return the
implant to the hot saline.
Allow the implant to cool completely to maintain the
achieved shape. Cold, sterile saline can accelerate the cooling process.
Reheat the implant as needed to achieve the final form
desired.
SynPOR HD Facial Shape System
Technique Guide
DePuy Synthes
13
Surgical Technique: Malar
3
Implantation
Lateral tab
Instrument
03.540.003
Implant Positioning Instrument
Malar implants are designed with registration tabs which
allow ideal and symmetric placement. The medial tab lies on
the lateral aspect of the infraorbital rim and the lateral tab
lies on the superior edge of the zygomatic arch. If a different
orientation is desired, the registration tabs can be removed
easily with a scalpel or burr.
The implant positioning instrument may be used to facilitate
placement of the implant.
Align the implant along the infraorbital rim and zygomatic
arch using the registration tabs on the implant as a guide to
ensure symmetrical placement of the left and right implants.
14
DePuy Synthes
SynPOR HD Facial Shape System
Technique Guide
Medial tab
4
Stabilization
Instruments
03.540.003
Implant Positioning Instrument
311.00X
Handles with Hexagonal Coupling
03.503.20X
Screwdriver Shaft Matrix MIDFACE,
self-holding, with Hexagonal Coupling
SynPOR HD Facial Shape Implants should be stabilized with
screws. Screw fixation is recommended to achieve the best
anatomical fit and planned reconstruction.
Screw fixation immobilizes the positioned implant and eliminates any gaps between the inner surface of the implant and
the surface of the facial skeleton.
The implant positioning instrument may be used to immobilize implants during fixation.
Immobilization and application of the malar implant to the
skeleton often requires the placement of 2 screws. One is
placed in the malar prominence, another is placed just
anterior to the zygomatic arch. When an intraoral approach
has been used the lateral extent of a blepharoplasty (crow’s
feet) incision provides access to the second (lateral) screw
position.
Compress the implant to the facial skeleton before drilling
and screw fixation.
Drill with the appropriate drill bit and insert the appropriate
length screw.
SynPOR HD Facial Shape System
Technique Guide
DePuy Synthes
15
Surgical Technique: Malar
Tighten screws sufficiently to eliminate the gaps between the
implant and the facial skeleton as well as to minimize
screw profile. Gaps between the implant and the skeleton
will result in an unanticipated increase in projection equivalent to the size of the gap. This may limit predictability of the
augmentation.
Precautions:
– Confirm that implant positioning, drill bit length and
screw length allow for adequate clearance of nerves,
tooth roots and other critical structures.
– Drill rate should never exceed 1,800 rpm. Higher rates can
result in thermal generated necrosis of the bone, and an
oversized hole to be drilled. The detriments of an oversized hole include reduced pullout force, increased risk
of screws stripping in bone, and/or suboptimal fixation.
Always irrigate during drilling.
– The implant can break or be damaged due to lack of fixation, excessive activity or trauma.
– Before closing all incisions, take care to remove all porous
polyethylene particles from the surgical site.
16
DePuy Synthes
SynPOR HD Facial Shape System
Technique Guide
Post-Operative Care
Adequate patient instruction is a key factor in determining
the success of the surgical procedure. Postoperative followup and care are very important. The patient must be made
aware that the implants are not as strong as natural tissue
and that excessive physical activity or load bearing may cause
loosening, migration, deformation, or fracture of the implants.
SynPOR HD Facial Shape System
Technique Guide
DePuy Synthes
17
Implants
SynPOR HD Implants
Must be ordered separately, not part of set (01.540.100)
A
C
SynPOR HD Chin Implants, round, sterile
A
B
C
08.540.100S
60 mm
36 mm
4 mm
08.540.101S
60 mm
39 mm
6 mm
08.540.102S
60 mm
41 mm
9 mm
B
A
SynPOR HD Chin Implants, square, sterile
A
B
C
08.540.110S
60 mm
36 mm
4 mm
08.540.111S
60 mm
39 mm
6 mm
08.540.112S
60 mm
41 mm
9 mm
C
B
C
SynPOR HD Malar Enhancer Implants, sterile
A
B
C
08.550.100S
48 mm
21 mm
3 mm
Right
08.550.101S
48 mm
21 mm
3 mm
Left
08.550.102S
47 mm
21 mm
4 mm
Right
08.550.103S
47 mm
21 mm
4 mm
Left
08.550.104S
48 mm
21 mm
5 mm
Right
08.550.105S
48 mm
21 mm
5 mm
Left
A
B
C
SynPOR HD Malar Shell Implants, sterile
A
B
C
08.550.110S
44 mm
22 mm
3 mm
Right
08.550.111S
44 mm
22 mm
3 mm
Left
08.550.112S
47 mm
23 mm
4 mm
Right
08.550.113S
47 mm
23 mm
4 mm
Left
08.550.114S
52 mm
23 mm
5 mm
Right
08.550.115S
52 mm
23 mm
5 mm
Left
18
DePuy Synthes
SynPOR HD Facial Shape System
Technique Guide
A
B
Screws
MatrixMIDFACE Screws ⭋ 1.5 mm, self-drilling, Titanium Alloy (TAN),
pack of 1 unit in Clip
Length
04.503.226.01C
6 mm
04.503.228.01C
8 mm
MatrixMIDFACE Screws ⭋ 1.5 mm, self-tapping, Titanium Alloy (TAN),
pack of 1 unit in Clip
Length
04.503.206.01C
6 mm
04.503.208.01C
8 mm
04.503.210.01C
10 mm
04.503.212.01C
12 mm
04.503.214.01C
14 mm
04.503.216.01C
16 mm
04.503.218.01C
18 mm
MatrixMIDFACE Emergency Screws ⭋ 1.8 mm, self-tapping, length 6 mm,
Titanium Alloy (TAN), pack of 1 unit in Clip
Length
04.503.236.01C
6 mm
04.503.238.01C
8 mm
04.503.240.01C
10 mm
04.503.242.01C
12 mm
04.503.244.01C
14 mm
04.503.246.01C
16 mm
04.503.248.01C
18 mm
04.540.001
Chin Connector
SynPOR HD Facial Shape System
Technique Guide
DePuy Synthes
19
Implants
Screw overview
Pack of 1 unit
Pack of 4 units
Labelling clips(LC)
Self-tapping screws
04.503.2XX.01C
04.503.2XX.04C
04.503.2XXLC
Self-drilling screws
04.503.22X.01C
04.503.22X.04C
04.503.22XLC
Emergency screws
04.503.2XX.01C
–
04.503.2XXLC
20
DePuy Synthes
SynPOR HD Facial Shape System
Technique Guide
Instruments
03.540.100
03.540.101
03.540.102
SynPOR HD Chin Sizer, round
4 mm
6 mm
9 mm
03.540.110
03.540.111
03.540.112
SynPOR HD Chin Sizer, square
4 mm
6 mm
9 mm
03.550.100
03.550.101
03.550.102
03.550.103
03.550.104
03.550.105
SynPOR HD Malar Enhancer Sizer
Right, 3 mm
Left, 3 mm
Right, 4 mm
Left, 4 mm
Right, 5 mm
Left, 5 mm
03.550.110
03.550.111
03.550.112
03.550.113
03.550.114
03.550.115
SynPOR HD Malar Shell Sizer
Right, 3 mm
Left, 3 mm
Right, 4 mm
Left, 4 mm
Right, 5 mm
Left, 5 mm
03.540.003
Implant Positioning Instrument
SynPOR HD Facial Shape System
Technique Guide
DePuy Synthes
21
Instruments
03.540.004
Cutting Board
03.507.005
Drill Guide 2.4
347.98
Holding Forceps for Plates
311.005
311.006
311.007
Handle with Hexagonal Coupling
small
medium
large
22
DePuy Synthes
SynPOR HD Facial Shape System
Technique Guide
Drill Bit ⭋ 1.1 mm, for J-Latch Coupling, with Stop
03.503.246
Length 44.5/6 mm
03.503.248
Length 44.5/8 mm
03.540.010
Length 65/12 mm
03.540.012
Length 65/25 mm
Drill Bit ⭋ 1.1 mm, for J-Latch Coupling, with Stop, sterile
03.503.246S
Length 44.5/6 mm
03.503.248S
Length 44.5/8 mm
Drill Bit ⭋ 1.1 mm, for Mini Quick Coupling, with Stop
03.503.286
Length 44.5/6 mm
03.503.288
Length 44.5/8 mm
03.540.011
Length 65/12 mm
03.540.013
Length 65/25 mm
Drill Bit ⭋ 1.1 mm, for Mini Quick Coupling, with Stop, sterile
03.503.286S
Length 44.5/6 mm
03.503.288S
Length 44.5/8 mm
Screwdriver Shaft MatrixMIDFACE, self-holding,
with Hexagonal Coupling
03.503.201
Short, length 52 mm
03.503.202
Medium, length 76 mm
03.503.203
Long, length 96 mm
Screwdriver Shaft MatrixMIDFACE, with Holding Sleeve,
with Hexagonal Coupling
03.503.205
Medium, length 79 mm
03.503.206
Long, length 95 mm
SynPOR HD Facial Shape System
Technique Guide
DePuy Synthes
23
SynPOR HD Facial Shape System
Sets
01.540.100
Screw and Instrument Set for SynPOR HD
Facial Shapes
01.540.110
Chin Implants for SynPOR HD
Facial Shapes
01.550.120
Malar Implants for SynPOR HD
Facial Shapes
Module
68.540.001
24
Module for SynPOR HD Facial Shapes,
for Implants and Instruments, with Lid,
without Contents
DePuy Synthes
SynPOR HD Facial Shape System
Technique Guide
References
1. Romano, James J., Nicholas T. Iliff. and Paul N. Manson.
“Use of Medpor Porous Polyethylene Implants in 140
Patients with Facial Fractures.” Journal of Craniofacial
Surgery 4.3 (1993): 142– 47. Print.
2. Yaremchuk, MJ. (2007). Atlas of facial implants. Saunders
Elsevier Inc.
3. Potter, J. and Ellis, E. (2004). Biomaterials for Reconstruction of the Internal Orbit. Journal of Oral and
Maxillofacial Surgery, 62: 1280–1297.
SynPOR HD Facial Shape System
Technique Guide
DePuy Synthes
25
Synthes is a trademark of Synthes, Inc. or its affiliates
Subject to modifications
© Synthes, Inc. or its affiliates
60100852
12/2013
This publication is not intended for distribution in the USA.
All technique guides are available as PDF files at
www.synthes.com/lit
0123
version AB
Ö036.001.509öABUä
036.001.509
Manufacturer:
Synthes GmbH
Eimattstrasse 3
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www.synthes.com