Use of Porous Polyethylene Implants in Nasal Reconstruction

Complex augmentation rhinoplasty to correct both functional and cosmetic deformities remains a challenge for the rhinoplasty surgeon. The skeletal structure maybe severely deformed from previous trauma or underlying disease processes. These resulting deformities may occur together with significant soft tissue disfigurement. Correction of all these aspects requires careful selection of graft material with a refined surgical technique. The correct choice of graft material for nasal reconstruction is critical. A number of grafts are now available, which is a pertinent indication that there is no single ‘perfect’ graft material available. Many characteristics have been indicated for an ‘ideal’ implant (Table 1), but there is still no single autologous or alloplastic material that fulfils all these criteria. For complex cases of nasal reconstruction, a considerable volume of graft may also be required. Autogenous tissues, including cartilage and bone, have been the primary choices to date. The principal reason for this has been their promise of biocompatibility, thereby reducing the risks of graft infection and rejection. However, autogenous grafts have their own limitations. These include donor site morbidity, a limited supply, potential warping of cartilage grafts and unpredictable bony resorption. These disadvantages have led to a surgence in the search of an alternative, suitable synthetic graft material. A number of alloplastic materials are now available, each with their own advantages and limitations. These include nonporous materials, which may provide smooth, soft tissue augmentation, but lack stability due to their inability to demonstrate host tissue in-growth. Alternatively, a number of porous materials are now available, which promote fibrovascular in-growth with the surrounding host tissue, which