Porous polyethylene implants in revision rhinoplasty: chances and risks

Introduction: High density Polyethylene (PE) is a chemically pure, porous plastic implant material that can perform supportive functions. The material has good tissue biocompatibility and permits ingrowth of connective tissue with related vascularization. The material is being used more frequently in nasal surgery. In this study we describe possibilities and limitations in the use of PE in rhino-surgery. Material and methods: Thirty-two charts of patients with rhinoplasty and PE-implantation were reviewed. All patients were seen in our department again. A database was created which included the following parameters: date and exact area of implantation, shape and thickness of the implant, number of revisions, technique of prior rhinoplasties, complications and the patients' satisfaction. Results: Seventy-five percent of patients were revision rhinoplasties at the time of surgery. Seven out of thirty two (21%) patients developed a complication. In four cases, the complication was managed with total explantation; three patient's condition required partial explantation. The shortest implantation period was only 24 days and the longest lasting implant within the complication group was explanted 266 days after implantation. All these patients had undergone multiple rhinoplasties before, with heavy scar tissue and septal perforations. The most frequent complication (n=4) was a partially extruded implant without any signs of infection in the area of the anterior septum. Discussion: Our descriptive study shows limitations in the use of PE for rhinoplasty. It seems crucial that the implant is completely covered with vital tissue, otherwise vascularization and healing is excluded. The implantation place should be vital and without any signs of infection. The covering tissue should not be too thin or scarred. An early infection of the open porous system prevents vascularization and healing and inevitably causes a rejection. The reason for the high complication rate (>20%) in this study lies in the specifications of the selected patient group at hand. All implantations were performed in seriously damaged scar tissue after multiple revision rhinoplasties. Due to the results of our evaluation we can recommend the use of PE: 1. in a vital, healthy implant site 2. with small material that can be embedded totally and without tension 3. in primary rhinoplasty or with only little scar tissue.