THE ROLE OF ALLOPLASTIC SKELETAL MODIFICATION IN THE RECONSTRUCTION OF FACIAL BURNS

The external appearance of the face is largely dictated by its support ing facial skeleton. After an extensive thermal injury, the underlying facial skeleton may need to be either augmented or restored to mainta in the functional and aesthetic appearance of the face. The factors th at make a structural reconstruction difficult are poor vascularity and compliance of the scar tissue, extreme contractile forces of the scar , and unstable skin coverage. The use of an alloplast in the setting o f facial burn scars may be one of the greatest challenges for an impla nt material. We reviewed our experience with the use of the Medpor por ous polyethylene implant in facial burn reconstruction. This biomateri al has structural characteristics that allow for tissue ingrowth, yet it resists deformation by contractile forces. A total of 57 consecutiv e implants were placed in 24 patients with facial burns. Implants were used for the chin, the nose, the malar region, and as an ear framewor k. Patient follow-up ranged from 6 months to 3 years. Although 4 impla nts became exposed and 1 was thought to become infected, only 1 of the implants was removed. There were no other implant-related complicatio ns. We believe that skeletal modification is an important step for a s uccessful facial burn reconstruction. Porous polyethylene offers a pro mising solution for the complex reconstructive problem of using an all oplast in the environment of a facial burn.