Porous polyethylene implants in facial reconstruction: Outcome and complications

Ridwan-Pramana, Angela; Wolff, Jan; Raziei, Ashkan; Ashton‐James, Claire E.; Forouzanfar, Tymour

doi:10.1016/j.jcms.2015.06.022

Cited by 64 publications

(47 citation statements)

References 30 publications

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“…This is due to its variability and adaptability, as its method of manufacture and formation can give it various physical properties tailoring it for a broad range of applications, from medical packaging to implants [83]. It can be manufactured as a porous structure, commonly used in cranioplasty applications, allowing for the creation of semi-rigid structures which are both strong and flexible and allow for alteration with minimal effort [60,84,85]. It must be noted that for certain applications such porous structures this material may not have the mechanical properties to act in load-bearing structures [86,87].…”

Section: Discussionmentioning

confidence: 99%

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Cranioplasty and Craniofacial Reconstruction: A Review of Implant Material, Manufacturing Method and Infection Risk

et al. 2017

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Background: Analysis of current literature highlights a wide variation in reported infection risk for different materials in cranial repair. The purpose of these composite materials are to mimic natural bone and assist in restoring function (structurally and aesthetically) to the human skull. This review aims to examine the meta-data in order to provide an amalgamated overview of potential trends between implant material, manufacturing method and infection risk, in order to provide a core reference point for future studies surrounding emerging biomedical materials in the fields of cranioplasty by providing base point for understanding the capabilities and limitations of current technologies. Methods: A search for articles was conducted, with the following criteria seen as fundamental in providing an accurate picture of the current landscape: publication in the last decade, provision of a numerical value for both number of implants and infection cases, patient sample of 10+, adult patients, and cranioplasty/cranial repair. Results: A total of 41 articles were seen to meet the author's inclusion criteria. Average infection rates per material ranged between 2.04% and 10.98%. The results indicate that there is variation between materials in regards to total infection risk, however, depending on the materials compared, this value may be insignificant. Alternative risk factors associated with infection, including surgical time, revisions and previous infection, have a greater impact on infection potential than material variation. Comparison of fabrication methods did highlight a notable effect on average infection rate. Trends can be observed showing that materials with greater levels of surface interaction and active support of tissue ingrowth presented greater infection resistance. Such characteristics are due to the physical structures of the implants. Conclusions: It can be said that the manufacturing methods can influence biomedical materials to assist in minimizing implant infection risk.

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Section: Discussionmentioning

confidence: 99%

“…This is shown in Table 8. One of most common form of PE used in cranioplasty applications is a porous mesh form [43,60,61]. The implant itself is a highly porous structure and is given an ISF ranking of 3.…”

Section: Polyethylene (Pe)mentioning

confidence: 99%

Cranioplasty and Craniofacial Reconstruction: A Review of Implant Material, Manufacturing Method and Infection Risk

et al. 2017

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“…'s series of 27 porous ethylene implants placed at the mandibular angle in 11 patients, 18.2% were dissatisfied. [16] Communication with the surgeon revealed that the actual percentage might be higher because of the retrospective nature of the study. This underscores the importance of preoperative design approval by the patient.…”

Section: Discussionmentioning

confidence: 99%

“…reported a 27.3% infection rate when using porous polyethylene in the mandibular angle area. [16] As porous ethylene is not osseointegrating,[17] it may become infected because fibrovascular ingrowth takes 3 months. [16] The implant can also migrate when not fixed with long enough screws, which may cause it to be exposed and extruded.…”

Section: Discussionmentioning

confidence: 99%

Guidelines for patient-specific jawline definition with titanium implants in esthetic, deformity, and malformation surgery

Mommaerts

2016

Ann Maxillofac Surg

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Context:Asymmetry and unfavorable esthetics of the jawline have become possible to correct in three dimensions using computer aided design and computer aided manufacturing.Aims:The aim of this study was to provide esthetic, technical, and operative guidelines for mandibular angle and border augmentation using patient-specific titanium implants made by selective laser melting.Settings and Design:University hospital - prospective registry.Subjects and Methods:Twelve patients and 17 implantation sites were documented and prospectively registered. Malformational, deformational, and purely esthetic indications were encountered.Statistical Analysis Used:Descriptive.Results:Patient satisfaction was high, probably because the patients had input into the planned dimensions and shape. A serious infection with implant removal occurred in one patient who had six previous surgeries at the same sites. Technical and surgical guidelines were developed including splitting implants into two segments when the mental nerve was at risk, using a three-dimensional (3D) puzzle connection, providing at least two screw holes per segment, using scaffolds at the bony contact side, using a “satin” finish at the periosteal side, referring to anatomical structures where possible, making provisions for transbuccal and transoral fixation, using a high vestibular incision, and using a double-layer closure. Esthetic guidelines are discussed but could not be upgraded.Conclusions:Mirroring techniques and 3D print accuracy up to 0.1 mm allow precise planning of jaw angle implants. Patients are pleased when given preoperative renderings for their consideration. Infections can be managed using technical and operative recommendations and careful patient selection.

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“…However, in spite of the best efforts, failures do occur due to a variety of factors [6]. Post operative infections are a major cause of reconstruction failures [7].…”

Section: Introductionmentioning

confidence: 99%

Finite element analysis of 6 large PMMA skull reconstructions: A multi-criteria evaluation approach

et al. 2017

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In this study 6 pre-operative designs for PMMA based reconstructions of cranial defects were evaluated for their mechanical robustness using finite element modeling. Clinical experience and engineering principles were employed to create multiple plan options, which were subsequently computationally analyzed for mechanically relevant parameters under 50N loads: stress, strain and deformation in various components of the assembly. The factors assessed were: defect size, location and shape. The major variable in the cranioplasty assembly design was the arrangement of the fixation plates. An additional study variable introduced was the location of the 50N load within the implant area. It was found that in smaller defects, it was simpler to design a symmetric distribution of plates and under limited variability in load location it was possible to design an optimal for expected loads. However, for very large defects with complex shapes, the variability in the load locations introduces complications to the intuitive design of the optimal assembly. The study shows that it can be beneficial to incorporate multi design computational analyses to decide upon the most optimal plan for a clinical case.

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Porous polyethylene implants in facial reconstruction: Outcome and complications

Cited by 64 publications

References 30 publications

Cranioplasty and Craniofacial Reconstruction: A Review of Implant Material, Manufacturing Method and Infection Risk

Cranioplasty and Craniofacial Reconstruction: A Review of Implant Material, Manufacturing Method and Infection Risk

Guidelines for patient-specific jawline definition with titanium implants in esthetic, deformity, and malformation surgery

Finite element analysis of 6 large PMMA skull reconstructions: A multi-criteria evaluation approach

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