Wrapping hydroxyapatite implants

Hydroxyapatite (HA) implants currently are most commonly wrapped in fresh u nprocessed human donor sclera before implantation to facilitate entry into the orbital space and allow extraocular muscle attachment. Autologous tempo ralis fascia or autologous fascia lata are alternatives, but prolong surger y time and require a second operative site. Recently, a number of other wra ps, such as processed human pericardium, processed human fascia lata, proce ssed human sclera, bovine pericardium and expanded polytetrafluoroethylene [e-PTFE], have being marketed. Although they also facilitate implant placem ent, they can be costly. Polygalactin (Vicryl, Ethicon, Somerville, NJ) mes h is another readily available wrap that is easy to use and cost effective. To obtain a high success rate with this wrap, the polygalactin mesh wrappe d HA implant must be moistened and seated into the orbit properly. If it is not, exposure may occur, which may explain why some surgeons shy away from its use. The proper technique is reviewed in this paper.