Hydroxyapatite Implant Wrapping Materials: Analysis of Fibrovascular Ingrowth in an Animal Model

Abstract

Although all of the implant wraps studied may be suitable substitutes for donor sclera, we prefer polyglactin mesh because it is readily available, inexpensive, and without risk of transmissible diseases.

Processed Fascia Lata as an Alternative Implant Material in Evisceration

“…21 With the technique proposed in the present study, such reinforcement may not be required since the material used to fill the scleral is also known to protect against exposure. 12,13,22 The fact that the subconjunctival presence of fascia lata strips (observed in patient 4) did not cause erosion of the overlying conjunctival layer and was well tolerated further supports this concept.…”

“…2,16 Implant exposure is a concern and sometimes a difficult-to-treat complication after evisceration. 18,19 This is why preventive strategies against extrusion are often used, including the use of anterior scleral reinforcement with various materials such as banked dura, 20 sclera, 21 fascia lata, 22 or pericardium. 21 With the technique proposed in the present study, such reinforcement may not be required since the material used to fill the scleral is also known to protect against exposure.…”

The Scleral Cap Technique for Porous and Nonporous Orbital Implants

“…Placement of a porous orbital implant (e.g., hydroxyapatite, bioceramic implant) within the soft tissue of the eye socket is facilitated by a wrapping material, which diminishes tissue drag with the porous implant and facilitates precise fixation of the extraocular muscles to the implant surface. 12,20,[25][26][27]31 The polyglactin 910 mesh around a nonporous implant (e.g., polymethylmethacrylate) makes the implant placement a little more difficult as the mesh is stickier than the unwrapped nonporous implant but moistening the wrapped implant with normal saline overcomes this issue. It is the precise fixation of the recti muscles to the nonporous implant wrap that is beneficial as this will allow more stability of the nonporous implant in the long-term.…”

“…44 Several alternative implant wraps have been suggested over the last 2 to 3 decades including specially processed human donor pericardium, fascia lata, processed bovine pericardium, autologous temporalis fascia, fascia lata, rectus abdominus sheath, postauricular muscle graft, microporous expanded polytetrafluoroethylene (e-PTFE), polycolic acid (Dexon mesh), and polyglactin 910 mesh. 20,[25][26][27]31 Undyed polyglactin 910 mesh (Vicryl knitted mesh, undyed, Ethicon, Somerville, New Jersey, USA) is a bioabsorbable synthetic material and is the authors preference as a wrapping material for porous and nonporous orbital implants. 20,[25][26][27]31 Polyglactin 910 mesh is readily available, simple to use, and does not require a second surgical site to harvest.…”

“…20,[25][26][27]31 Undyed polyglactin 910 mesh (Vicryl knitted mesh, undyed, Ethicon, Somerville, New Jersey, USA) is a bioabsorbable synthetic material and is the authors preference as a wrapping material for porous and nonporous orbital implants. 20,[25][26][27]31 Polyglactin 910 mesh is readily available, simple to use, and does not require a second surgical site to harvest. It is also bioinert, nontoxic, absorbable and non-antigenic.…”