Complications Associated with Use of Porous High-Density Polyethylene in Rhinoplasty

Overview

Porous high density polyethylene has been used as an alternative to cartilage for grafting in rhinoplasty, but concerns remain about infection and the graft working its way out through the skin. The study analysed the relationship between complication rates and where the graft sat relative to the shear force applied when the nose is handled from outside. It was a retrospective review over a 10 year period.

Sections of note

• Retrospective review of 116 patients over 10 years.
• Minor complications occurred in 3.4 percent of patients, all resolving without surgery.
• Major complications, meaning infection or extrusion, occurred in 5.2 percent of all patients.
• Those major complications appeared at an average of 36.9 months after surgery.
• All major complications occurred in patients whose grafts extended into the caudal, or lower, part of the nose.
• Two thirds of the major complications ultimately required surgery.
• The authors conclude grafts contained in the upper part of the nose are less prone to failure.
• Long term follow up is recommended for all such patients because of the risk of delayed complications.

What it means for a patient

• The synthetic graft failed only where it extended into the mobile lower nose, which is subject to pressure and movement from outside.
• Failures appeared on average three years after surgery, long after the patient would consider healing complete.
• About one patient in 19 had a major complication, and most of those needed further surgery.
• This is a retrospective single centre review without a comparison group using cartilage.

Why this paper matters

Synthetic grafts avoid harvesting cartilage but carry infection and extrusion risk, and where they are placed has not been systematically linked to that risk. This study makes that link and finds it concentrated in one location. Whether restricting placement eliminates the risk has not been tested prospectively.

Terms

• Porous high density polyethylene: a rigid synthetic implant material that tissue can grow into.
• Extrusion: a graft working its way out through skin or lining.
• Caudal nose: the lower part of the nose toward the nostrils.
• Cephalic: toward the upper part of the nose, near the eyes.
• Shear force: sideways pressure applied across a structure, here from handling the nose.
• Conservative management: treatment without further surgery.