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Porous Polyethylene Implant Fibrovascularization Rate Is Affected by Tissue Wrapping, Agarose Coating, and Insertion Site

Soparkar, Charles N. S. M.D., Ph.D.*†; Wong, Jamie F. M.D.*; Patrinely, James R. M.D.*†‡; Davidson, Joseph K. M.D.*; Appling, Douglas M.D.§

Ophthalmic Plastic and Reconstructive Surgery: September 2000 - Volume 16 - Issue 5 - p 330-336

Purpose Often used in facial and ocular reconstruction, biointegratable materials, such as hydroxyapatite and high density porous polyethylene, can be associated with migration, exposure, and infection. Complications are less likely after implants become fibrovascularly integrated. A model was sought to study the influence of multiple factors on the rate of fibrovascular ingrowth into porous implants.

Methods High density porous polyethylene cubes were implanted into paraspinous skeletal muscles in rabbits. The cubes were explanted at weekly intervals using survival surgery. The number of fibroblasts at the center of each cube was counted, generating a time-dependent standard curve of cell accumulation. Porous polyethylene cubes uncoated, coated with agarose (a plant-derived carbohydrate), or coated with nonperforated sclera (human or rabbit) were implanted into suprascapular adipose and paraspinous skeletal muscle in other rabbits.

Results Fibrovascular ingrowth occurred more rapidly with cube implantation into skeletal muscle versus adipose, with increased surface area contact between implants and muscle, and with removal of muscle capsules. While the rate of fibroblast accumulation decreased in cubes coated with sclera, coating the cubes with agarose increased the fibrous capsule formation without altering the rate of biointegration.

Conclusions This study provides a novel approach for the study of fibrovascular ingrowth into implants treated under a variety of conditions. Modification of current surgical techniques may increase the rate of porous polyethylene implant biointegration.

*Plastic Eye Surgery Associates, PLLC, Houston, and Cullen Eye Institute, Department of †Ophthalmology, ‡Division of Plastic Surgery, and §Department of Otolaryngology, Baylor College of Medicine, Houston, Texas, U.S.A.

Accepted March 20, 2000.

Supported in part by grants from the American Federation for Aging Research, New York, New York and the Heed Ophthalmic Foundation, Cleveland, Ohio.

Address correspondence and reprint requests to Dr. Charles N. S. Soparkar, Plastic Eye Surgery Associates, PLLC, 6500 Fannin Street, Suite 1100, Houston, TX 77030, U.S.A.

© 2000 Lippincott Williams & Wilkins, Inc.