Porous Polyethylene Implants Research Articles

Extrusion of High-density Porous Polyethylene Implants in the Nose.

Few alloplastic implant materials have been successfully used in nasal reconstruction. The high-density porous polyethylene (HDPE) implant is the most widely accepted alloplastic material for reconstructing the nasal structure. Some authors suggest that the problems associated with using grafts and biocompatible materials are often due to errors on the part of the surgeon or the technique used. This study aims to report several cases of complications related to using HDPEs in the nose. A total of 23 patients who reacted negatively to alloplastic implants were treated. The removal of HDPE is complex due to the formation of connective tissue within it. These complications can cause permanent atrophic changes to the skin of the nose. Most of the patients presented with extrusion of their HDPE implants in the nasal columella region. All patients underwent implant removal, cleaning, disinfection, and secondary rhinoplasty. Surgeons must be able to recognize these possible complications and manage them successfully. Even today, many professionals use alloplastic grafts for reconstruction and esthetics of the nasal region. The potential for permanent damage to the skin and soft tissues, as well as complications such as infection and extrusion of the implant, makes the use of autogenous tissue preferable over alloplastic implants. Early detection and immediate treatment of complications are essential to minimize the severity of the deformity.

Short-Term Outcomes of High-Density Porous Polyethylene Orthoses for Chin and Gonial Angle Augmentation.

This retrospective observational study evaluated 100 patients over 18years. Data on age, sex, aesthetic complaints, surgery types, and postoperative complications were collected and analyzed using the two-proportion z-test and descriptive statistics in RStudio 4.3.3. All patients with neuropraxia underwent neurosensory evaluation. The average age was 35.92years for males and 33.71years for females, with a male predominance (76%). Aesthetic complaints were prevalent in 72% of patients (p < 0.01). Chin surgery was performed on 56% of patients, jaw angle surgery on 17%, and both on 39%. Complications included one case of suture dehiscence, three wound infections, and four transient cases of paresthesia, all resolving within 30days. Overall, patient satisfaction with outcomes was high. High-density porous polyethylene implants proved effective and safe in enhancing facial aesthetics and correcting mandibular deformities. Further research should focus on long-term outcomes to consolidate these findings. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Auricle reconstruction with autologous costal cartilage versus polyethylene implants in microtia patients: a meta-analysis.

Auricle reconstruction is among the most challenging procedures in plastic and reconstructive surgery, and the choice of framework material is a critical decision for both surgeons and patients. This meta-analysis compared the outcomes of autologous auricle reconstruction using costal cartilage with those of alloplastic reconstruction using porous polyethylene implants. A literature review was conducted using the PubMed and Embase databases to retrieve articles published between January 2000 and June 2024. The outcomes analyzed included postoperative complications such as framework exposure, infection, skin necrosis, hematoma, and hypertrophic scars, as well as patient satisfaction. The proportions of reconstructive outcomes from each selected study were statistically analyzed using the "metaprop" function in R software. Fourteen articles met our inclusion criteria. The group undergoing polyethylene implant reconstruction exhibited higher rates of framework exposure, infection, and skin necrosis, whereas the autologous reconstruction group experienced higher rates of hematoma and hypertrophic scars. Of all the complications, framework exposure was the only one to show a statistically significant difference between the two groups (p < 0.0001). In terms of patient satisfaction, those who underwent autologous cartilage reconstruction reported a higher rate of satisfaction, although this difference did not reach statistical significance in the meta-analysis (p = 0.076). There is no statistically significant difference in postoperative complications such as infection, hematoma, skin necrosis, and hypertrophic scars between auricle reconstructions using autologous costal cartilage and those using polyethylene implants. However, reconstructions with polyethylene implants show a significantly higher rate of framework exposure.

CURRENT APPROACHES TO MANAGING MICROTIA

Microtia, a developmental anomaly of the external ear resulting in a deformed auricle, affects 1 to 5 individuals per 10,000. Literature suggests a male predominance, with nearly 2.5 times more male patients affected than females. Additionally, there is a notable right-sided predilection, leading to pronounced asymmetry, observed in approximately 83% of cases. Surgical reconstruction is the primary treatment for microtia, albeit a technically demanding procedure with challenges in achieving optimal aesthetic outcomes. Reconstruction typically involves autologous costal cartilage, known for its effectiveness but requiring advanced surgical skills. Complications, including pneumothorax, postoperative pain, chest wall deformity, and pathological scarring, are common with this approach. In recent years, surgeons have increasingly adopted modern techniques utilizing porous high-density polyethylene implants for reconstruction. This approach is gaining popularity due to the challenges associated with achieving satisfactory cosmetic results using autologous costal cartilage reconstruction. Based on the bibliosemantic and analytical methods employed to analyze the literature, we posit that this topic necessitates further investigation and a multidisciplinary approach. The involvement of otolaryngologists and maxillofacial surgeons is imperative for the comprehensive treatment of this pathology.

Contemporary Treatment of Microtia-Atresia.

Microtia-atresia is a congenital deformity affecting the external ear and ear canal that can present with varying degrees of severity and morbidity. Treatment occurs along a spectrum and primarily centers on improving aesthetic appearance. Many cases of microtia will not be effectively treated with conservative measures and will require some form of reconstruction. There are several options available, including porous polyethylene implants, autologous rib grafting, and autologous chondrocyte frameworks. Equally significant is the treatment of hearing loss, as many patients with microtia-atresia will have a component of conductive hearing loss. This article aims to comprehensively review contemporary treatment modalities for microtia-atresia and discuss the advantages, disadvantages, and practicality of each. Treatment and reconstruction often take a multidisciplinary and multistaged approach to achieve optimal results, with ideal management determined by each patient's individualized needs.

Otolaryngology Implants Usage and their Material Adverse Event Profile - A Narrative Review

Objectives:The objective of this study is to review various biomaterials or implants used in ENT and their adverse effects on events that were noticed from the initial days to the present era.Methods:Relevant articles were searched from the databases. PubMed, Scopus, Web of Science, and Google were used to search for the data.Results:Cochlear implant (CI) adequacy depends on biocompatibility, anti-inflammatory treatment, and reduction of fibrosis. Silicone is used in the otologic field, and its allergy is a rare cause of CI extrusion. Nitinol pistons are used in stapedotomy, and polyethylene (Teflon) grafts are used in partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP). Their complications include graft extrusion and residual perforation. Chronic sphenoid sinusitis is associated with Medpor porous polyethylene implants used for sellar reconstruction in skull-based surgeries. In vocal cord paralysis, injectable collagen preparations form submucosal deposits and dysphonia. Montgomery T-tubes are used in subglottic stenosis, and they produce granulation tissue. Metallic tracheostomy tubes cause the formation of secondary foreign bodies, and biofilms appear in double-lumen tracheostomy tubes.Conclusion:Even though several research studies have been carried out, still a modification of implant design is needed to minimize the complications and to further promote the quality of life of patients.

Outcome of porous polyethylene implants in anophthalmic sockets with implant migration

Purpose: To evaluate the surgical outcome of porous polyethylene orbital implants in anophthalmic sockets with implant migration. Methods: A prospective interventional case series: Patients of anophthalmic sockets with implant migration were recruited, which were replaced with porous polyethylene implants. Patients were evaluated for recurrence of implant migration, ability to wear artificial eye, movement of prosthesis, complications, and satisfaction. Results: Fifteen patients with a mean age of 8.33 years were operated for implant migration. Postoperatively, recurrence of implant migration was seen in one patient. Fourteen patients were able to wear the artificial eye. The overall mean prosthetic motility at 6 months of follow-up was 26% of the contralateral eye. Enophthalmos (&gt;2 mm) and pseudoptosis (&gt;2 mm) were present in 2 patients each. Satisfaction was good in 10 patients and fair in 5 patients. Conclusion: The recurrence of implant migration was almost nil with the use of porous polyethylene orbital implant in a follow-up of 6 months. A majority (93%) of the patients could wear the artificial eye with good satisfaction.

Anophthalmic socket in retinoblastoma: Exploring complications and risk factors in a tertiary centre in Malaysia.

To evaluate the complications of anophthalmic socket in retinoblastoma patients at a tertiary centre in Malaysia. Retrospective study. Patients who underwent enucleation for retinoblastoma were reviewed from 2004-2020. Details were recorded, including demographics, diagnosis, surgical techniques, implant types, additional therapies, and complications. Of 250 patients with retinoblastoma managed over the period, the anophthalmic sockets of 160 eyes who underwent enucleation were analysed. The mean age at enucleation was 2.03 years (26 days to 9.18 years). The follow-up periods after enucleation range from 5 days to 16.83 years. Porous polyethylene (Medpor) implants were used in 135 patients (84.4%), as were Bioceramic in 9, glass balls in 7, acrylic in 7, dermis fat grafts in 1, and silicone implants (Aurosphere) in 1. The overall complications in our study were 28.8%. Complications seen in the study included implant exposure (12.5%), shallow inferior fornix (10.6%), granuloma formation (3.1%), discharge (2.5%), implant migration (1.9%), ptosis (0.6%), and orbital dystopia (0.6%). Implant exposure is solely found in Medpor, more common in those with donor sclera caps, and exposure times range from 28 days to 11.42 years. The suturing of the Tenon and conjunctiva in separate layers significantly reduced the rate of implant exposure. Six out of seven radiation patients had shallow inferior fornixes. Long-term post-enucleation complications were not uncommon. Luckily, most had good outcomes, with a few needing surgical intervention. Meticulous suturing technique on the Tenon and conjunctival layer is essential to prevent implant exposure.

Aesthetic Reconstruction of an Old Burr Hole Defect Using a Cancellous Bone Chip and a Porous Polyethylene Implant.

Burr hole trephination is a minimally invasive procedure but can leave a depressed scar at the surgical site. Various materials have been studied to fill such defects; however, to the best of our knowledge, there are no reports of reconstructing old, depressed scars from burr hole surgery. This report presents a patient with depressed scarring near the anterior hairline of the frontal bone on both sides due to burr hole trephination for a subdural hematoma 27 years prior. Computed tomography scans revealed bony defects under the scar. Reconstruction of the bony defect was performed by debriding the bony bed, filling it with hydrated alloplastic cancellous bone, and covering it with a porous SynPOR polyethylene titanium-reinforced implant. During 1 year of follow-up, the reconstruction was maintained without complications. The patient was satisfied with the esthetic outcome. Thus, old bony defects can be repaired using the appropriate materials and techniques.

Repair of Congenital Enlarged Parietal Foramina With Porous Polyethylene Implants.

Enlarged biparietal foramina is an autosomal dominant disorder that is caused by a failure of completion of ossification within the parietal bones. Enlarged parietal foramina measuring more than a few millimeters are uncommon. Even though spontaneous regression has been described, closure is rarely complete, and depending on the size of the resulting defect, an unprotected brain is a concern. There are few reports on the surgical management of persistent enlarged biparietal foramina. This is the first report describing our experience with a custom porous polyethylene implant.

Anatomical Reconstruction of Extensive Inferomedial Blow-Out Fractures Involving the Inferomedial Orbital Strut Using a Single Fan-shaped Titanium-Reinforced Porous Polyethylene Plate.

Extensive inferomedial blow-out fractures involving the inferomedial orbit strut frequently result in severe ophthalmic complications. Therefore, anatomical reconstruction is essential but is still technically challenging. Thus, the authors have used a novel technique using a combination of single fan-shaped titanium-reinforced porous polyethylene (TR-PPE) implants and a bidirectionally extended transconjunctival approach. Herein, the authors describe our surgical technique and discuss its effectiveness. First, the transconjunctival approach was performed and was subsequently extended medially using the transcaruncular approach and laterally using lateral blepharotomy. After the origin of the inferior oblique muscle was identified, a trimmed fan-shaped TR-PPE implant was inserted into the orbital floor. It was subsequently rotated and bent at the site of origin of the IO muscle and moved upward to cover the superior bony ledge of the medial wall. Finally, the implant was fixed to the orbital rim. Anatomical orbital reconstruction was confirmed by a computed tomographic scan. The preoperative diplopia in 19 patients, resolved within 1 week in 16 patients and in 3 to 6 months in the remaining 3 patients. Preoperative enophthalmos >2mm in all patients improved to <2mm in 67 patients and 3mm in 2 patients (>7mm preoperatively). The postoperative course was uneventful, and no severe complications were observed. The authors believe that the placement of a fan-shaped TR-PEE implant into the orbit through the bidirectionally extended transconjunctival approach could be a viable option for the anatomical reconstruction of extensive inferomedial blow-out fractures involving the inferomedial orbital strut.

Facial masculinization surgery

Facial masculinization surgery

Patient-Specific Orbital Implants Vs. Pre-Formed Implants for Internal Orbital Reconstruction

ABSTRACT Purpose To compare the outcome of orbital blowout fracture repair by means of pre-formed porous-polyethylene titanium implants (PFI) vs patient-specific porous-polyethylene implants (PSI). Methods Retrospective cohort study. Baseline characteristics, ophthalmic examination results, ocular motility, fracture type, the timing of surgery, implant type, and final relative enophthalmos of all patients operated on for blow-out fractures in a single center were collected and analyzed. Results Twenty-seven patients (mean age 39 years, 9 females) were enrolled. Sixteen underwent fracture repair with PFI and 11 with PSI at 11 months (median) post-trauma. Mean follow-up duration was 1.1 years. Both groups showed significant postoperative improvement in primary or vertical gaze diplopia (P = .03, χ2). Relative enophthalmos improved from −3.2 preoperative PFI to −1.7 mm postoperative PFI, and from −3.0 mm preoperative PSI to −1.1 mm postoperative PSI (P= .1). PSI patients had non-significantly less postoperative enophthalmos and globe asymmetry than PFI patients. The outcome was not influenced by previous surgery, age, sex, number of orbital walls involved in the initial trauma, or medial wall involvement (linear regression). Both groups sustained complications unrelated to implant choice. Conclusion Both PSI and PFI yielded good outcomes in this study. PSI may be a good alternative to PFI in primary or secondary orbital blowout fracture repair with less enophthalmos and globe asymmetry, in spite of the possible disadvantages of production time, a relatively larger design, and challenging insertion. Since it is a mirror image of the uninjured orbit, it may be beneficial in extensive fractures.

Pediatric Postburn Ear Reconstruction of Significant Cartilage Defects.

The external ear is a vulnerable appendage susceptible to trauma. Repairing and recreating its intricate architecture presents a formidable challenge after burn injury, especially when scar tissue, impaired vasculature, and damage to cartilage all influence reconstructive options. The authors share their institutional experience and provide a guide for reconstruction of significant postburn auricular cartilage defects. A retrospective review was conducted on 54 patients (61 ears) aged 0-21 years old admitted to a specialized pediatric burn hospital between January 2004 and January 2021 for postburn ear cartilage reconstruction. Conchal cartilage grafting was performed in 9 patients (9 ears) with an average age of 14.0 ± 5.1 years, requiring an average of 2.0 ± 1.0 procedures that resulted in one case of infection. A total of 21 patients (24 ears) with an average age of 15.1 ± 4.5 years underwent a conchal transposition flap, requiring an average of 1.8 ± 0.4 procedures that resulted in no major complications. A total of 20 patients (23 ears) with an average age of 12.0 ± 5.3 years underwent porous polyethylene implantation, requiring an average of 3.5 ± 1.5 operations that resulted in 3 complications. Costal cartilage grafting was performed in 4 patients (5 ears) with an average age of 13.2 ± 5.3 years, requiring an average of 3.2 ± 2.2 operations that resulted in one case of infection. Postburn ear cartilage defects necessitate an individualized approach tailored to a patient's reconstructive goals. In addition to defect size and location, factors such as reconstructive course duration, complication potential, and anticipated aesthetic results should be discussed with the patient.

Alloplastic malar implants in aesthetic facial surgery.

To examine the recent literature on aesthetic alloplastic malar implants. Alloplastic implantation is heavily favored in the oromaxillofacial literature. Recent articles have examined porous polyethylene and silicone implantation. Overall patient satisfaction is high and complications are low. Outcomes are likely comparable with alternative modalities to rejuvenate the face in the appropriate hands. Alloplastic implantation continues to be a reliable tool for malar augmentation.

88 Pediatric Postburn Ear Reconstruction of Significant Cartilage Defects

IntroductionThe ear is a protruding appendage with multiple functional and aesthetic implications. Literature indicates that up to 40-60% of facial burns involve the ear. Ear burns with considerable tissue loss and sensory deficits can negatively impact quality of life, psychosocial functioning, and physical health. Successful ear reconstruction mitigates these undesirable outcomes. The complex architecture of the external ear presents a formidable surgical challenge after burn injury, when scar tissue, impaired blood supply, and trauma to cartilage all influence reconstructive options. A lack of materials that truly replicate the characteristics of uninjured elastic cartilage also presents a longstanding surgical dilemma. In this retrospective study, the authors highlight the utility of reconstructive techniques to address significant cartilage deficits, including conchal transposition flap, composite graft, costal cartilage graft, and porous polyethylene implant.MethodsA retrospective review was conducted on patients aged 0 to 21 years who underwent cartilage framework reconstruction between January 2004 to January 2021 at a specialized pediatric burn center. Medical records from the hospital’s patient database were screened, and 52 patients (60 ears) who met study criteria were identified. Patient demographics, procedural characteristics, and patient outcomes were analyzed.ResultsFor helical rim cartilage defects, 20 patients (23 ears) with an average age of 15 ± 4 years underwent a conchal transposition flap, which was associated with no major complications. In cases involving repair of small to medium cartilage deficits, 9 patients (9 ears) with an average age of 13 ± 5 years underwent a composite graft, which was associated with one case of infection. A total of 20 patients (23 ears) with an average age of 13 ± 6 years underwent porous polyethylene implantation, which was associated with two cases of exposure and one case of infection. Of these porous polyethylene cases, 20 ears involved helical rim reconstruction and 3 involved total ear reconstruction. Costal cartilage grafting was performed in 4 patients (5 ears) with an average age of 13 ± 5 years and was associated with one case of infection. Costal cartilage grafting was utilized to reconstruct 2 helical rims and 3 total ears.ConclusionsIn cases of focal cartilage defects or medium-sized helical rim cartilage loss, highly aesthetic results and minimal complication rates can be achieved with composite graft or conchal transposition flap. When presented with large to total helical rim loss or total ear loss, either costal cartilage graft or porous polyethylene implantation is typically necessary.

Porous Polyethylene Implants in Orbital Floor Reconstruction: Outcome and Complications

Porous Polyethylene Implants in Orbital Floor Reconstruction: Outcome and Complications

Patient specific implants in orbital reconstruction: A pilot study

PurposeSuccessful repair of the orbital skeleton restores function and cosmesis by normalizing globe position and allowing full motility of the extraocular muscles. Routine repairs are successful with standard implants. However, defects that are irregular or cause volume deficiency can be challenging to repair. The development of patient specific implants (PSI) offers an additional tool in complex cases. Herein, we report our experience using PSI for orbital reconstruction. MethodsAn IRB-approved review was conducted of consecutive patients who received PSI from 8/2016–9/2018. Demographic and examination findings were recorded. PSI was designed using high-density porous polyethylene or polyetheretherketone (PEEK) and implanted for repair. The postoperative course was reviewed for outcomes and complications. ResultsEight patients were identified. Two had silent sinus syndrome, 3 were complex facial fracture revisions, and 3 were post-oncologic reconstruction. Seven received porous polyethylene implants, and 1 had a PEEK implant. Mean follow up time was 10.2 months (3.3–28.3). All had an improved functional and aesthetic result. Diplopia and enophthalmos completely resolved in 60% of fracture and silent sinus patients. All fracture and silent sinus patients were orthotropic without diplopia in primary gaze at last follow up. Tumor patients had improvement in symmetry and functionality. There were no complications. Conclusion and importanceComplex orbital skeleton derangements can be difficult to repair and standard implants may incompletely resolve the anatomic problem. In challenging cases, PSI may better achieve an aesthetically and anatomically successful outcome and improve functionality.

Surface Modification of Porous Polyethylene Implants with an Albumin-Based Nanocarrier-Release System.

Background: Porous polyethylene (PPE) implants are used for the reconstruction of tissue defects but have a risk of rejection in case of insufficient ingrowth into the host tissue. Various growth factors can promote implant ingrowth, yet a long-term gradient is a prerequisite for the mediation of these effects. As modification of the implant surface with nanocarriers may facilitate a long-term gradient by sustained factor release, implants modified with crosslinked albumin nanocarriers were evaluated in vivo. Methods: Nanocarriers from murine serum albumin (MSA) were prepared by an inverse miniemulsion technique encapsulating either a low- or high-molar mass fluorescent cargo. PPE implants were subsequently coated with these nanocarriers. In control cohorts, the implant was coated with the homologue non-encapsulated cargo substance by dip coating. Implants were consequently analyzed in vivo using repetitive fluorescence microscopy utilizing the dorsal skinfold chamber in mice for ten days post implantation. Results: Implant-modification with MSA nanocarriers significantly prolonged the presence of the encapsulated small molecules while macromolecules were detectable during the investigated timeframe regardless of the form of application. Conclusions: Surface modification of PPE implants with MSA nanocarriers results in the alternation of release kinetics especially when small molecular substances are used and therefore allows a prolonged factor release for the promotion of implant integration.

Facial Masculinization from Procedures to Payment: A Review.

As the demand for gender-affirming procedures continues to increase, patients and providers have a greater imperative to understand the current state of facial masculinization. Facial reconstruction for transgender women has been shown to treat gender dysphoria effectively and reduce rates of discrimination and victimization. Although facial masculinization surgery for transgender men is less common, there are multiple surgical and nonsurgical options to supplement the effect of hormone therapy on facial appearance, including but not limited to: receding the hair line, flattening the forehead, expanding the supraorbital ridge, increasing the dorsal nasal projection, squaring the jaw, and augmenting the chin. This review aims to summarize these techniques for providers who wish to inform transgender male patients about their options and discuss them in the context of patient satisfaction and availability of insurance coverage.