Long-term results of high-density porous polyethylene implants in facial skeletal augmentation: An Indian perspective

Abstract

Context: With the increasing emphasis on well-sculpted facial features, today there is a growing need for tools to augment the facial skeleton; either for cosmetic reasons or to re-contour deformities—congenital, post-traumatic and post-ablative. The limitations of autogenous materials has lead to evolution of numerous ‘alloplasts’, of which, high-density porous polyethylene (HDPE) seems to be a promising alternative. Aims: To evaluate the long term results of HDPE in facial skeletal augmentation in terms of achieving desired facial contour, patient satisfaction and complications. Settings: A tertiary care referral centre in a metropolitan set-up. Design: Case Series Materials and Methods: All patients undergoing HDPE implant insertion for facial skeletal augmentation between July 2001 and November 2009 were included in the study. A total of 70 HDPE implants were inserted in 44 patients. All procedures were performed by a single surgeon following standardized pre, intra and post-operative protocols. The results were evaluated with respect to improvement in facial contour desired and achieved, overall patient satisfaction and complications encountered. Results: The study included 44 patients with a male:female ratio of 1:1, a mean age of 25.09 years (14 to 58 years) and a mean follow-up of 45.34 months (0.5 to 100 months). HDPE implants were used to augment the nasal dorsum, maxilla, malar eminence, chin, mandibular body and angle, orbital rim and frontal region. The overall recontouring afforded by the HDPE implants was good, with most patients reporting satisfactory results. There were seven complications (10%), including three cases of deviation (4.29%), three cases of exposure (4.29%) and one case of sub-clinical infection (1.43%). None however necessitated implant removal. Nasal dorsal HDPE implants, especially those involving secondary surgery, suffered a much higher complication rate compared to other implants. Conclusions: HDPE is an alternative to autogenous grafts for facial skeletal augmentation with good long-term results and a low incidence of complications, provided there is adequate vascular soft tissue cover.

Development of a Smart Scaffold for Sequential Cancer Chemotherapy and Tissue Engineering

“…The inherent problem of HDPE scaffolds in tissue engineering is their reported slow integration with fresh tissue. − This is mainly ascribed to their hydrophobic nature. Some of us earlier reported a procedure where with the help of plasma treatment and metallic nanoparticles, this shortcoming could be circumvented. , We followed a similar strategy , to design the dual-functional scaffold as part of this study.…”

“…Much research has been done on the topic of polymeric scaffold properties such as surface topographic features (roughness and hydrophilicity) and scaffold microstructures (pore size, porosity, pore interconnectivity, and pore and fiber architectures) that influence the cell–scaffold interactions. , Among the different options available, scaffolds made with the exceptionally biocompatible and nonbiodegradable high-density polyethylene (HDPE) are still the most preferred ones because of many advantages (e.g., flexibility in the size of pores, high tensile strength, expansion coefficient, enhanced surface area, sturdiness, etc. ). , Unfortunately, HDPE-type polymers have a slower rate of integration with the active tissue which is mainly due to their inherent high hydrophobicity. − Thus, scaffolds made up of such hydrophobic polymers would require a long “healing time”. This is the second problem that needs to be dealt with.…”

Cranial reconstruction using prefabricated direct 3DP porous polyethylene

“…Apart from these routine clinical examinations, 3D CT scanning was also performed by using a helical 128-slice CT (Somatom Definition AS, Siemens, USA) at 2, 6, 12 and 24 months postoperatively for further evaluation of the bone ingrowth into the implant. The maximum follow-up time of 24 months period was selected as a primary end point to evaluate the safety and bone ingrowth capability of the 3DP PE implant since the complications and bone unions could occur within two years after surgery (Deshpande and Munoli, 2010; Alonso-Rodriguez et al , 2015; Williams et al , 2015; Zanotti et al , 2015; Hong et al , 2005; Kanno et al , 2016). For 3D CT bone ingrowth analysis, CT data set of patient’s skull was acquired and reconstructed similarly to the implant design stage.…”