Experience with prefabricated silicone implants for reconstruction in facially deformed patients

The fate of folded and unfolded dermal grafts: a histopathologic and structural study of rabbits

Currently, both autogenous and nonautogenous materials are used to treat contour deformities. Autogenous grafts are preferable to nonautogenous grafts because they cause less reaction and are both inexpensive and easy to obtain. Currently, however, no consensus exists on an ideal autogenous graft. As autogenous materials, dermal grafts can be obtained from scar tissue, allowing simultaneous revision of scars, quicker vascularization than with other autogenous tissues, and a very short immobilization for their stabilization (i.e., they interact with surrounding tissues). The operation can be performed with the patient under local anesthesia, providing regular contours easily. Alternative techniques are needed to increase the viability and mass effects of autogenous grafts in the long term. With this as the objective, folded dermal grafts were used to increase the mass effects of dermal grafts. The current study compared long-term histopathologic and structural changes in unfolded and folded dermal autogenous grafts used for correction of soft tissue contour deformities. Thicknesses and histopathologic changes of the unfolded and folded dermal autogenous grafts were evaluated 6 and 12 months after placement of the grafts in the abdomens of 10 rabbits. Both the authors' observations and histopathologic examinations showed that the folded dermis caused a more severe granulomatous reaction and fibrosis. Graft thicknesses considerably increased in the first 6 months, but then almost leveled off in the following months. Increased fibrosis in the folded grafts had a masslike effect, which was preserved in the long term, suggesting that folded dermal grafts can be used clinically.

Complications and toxicities of implantable biomaterials used in facial reconstructive and aesthetic surgery: a comprehensive review of the literature

The use of implantable biomaterials has become an integral part of aesthetic and reconstructive surgery of the face. Metals are used for fracture fixation devices, whereas polymers are used primarily for bone or soft-tissue substitution. This review of the scientific literature examines the risks and complications of these materials. First, we present an overview of commonly used materials. Second, we address general considerations of toxicity relevant to all biomaterials. Third, we present data from a large number of clinical series on the incidence of complications for individual materials used in specific applications.

Cranioplasty with a silicone prosthesis and split rib grafts

A method to reconstruct visible cranioplasty defects involving the anterior cranium with the durability of bone and the exacting contours of the custom silicone implant is described. This technique is simple, quick, and does not require intraoperative assessment of subtle contours. The patient has a rigid underlying bony support with a perfectly contoured external surface. In patients with cranioplasty involving the cranium anterior to the hairline, we take advantage of both split rib grafts and a silicone prosthesis in one stage to obtain optimal results.

Facial defect augmentation with a dermal-fat graft

The augmentation of facial soft-tissue defects can pose a difficult problem for the surgeon. Bone tends to resorb, giving unpredictable results, and alloplastic materials are firm to the touch and can migrate in the tissues. The dermal-fat graft provides a soft, natural-appearing augmentation. In the case reported here a 2-year follow-up shows excellent results obtained with the use of a dermal-fat graft to augment a soft-tissue defect over the mandible.

Proplast augmentation for posttraumatic zygomatic deficiency

Facial deformities following fractures of the zygomatic complex are common. Included in this article are the indications, work-up, and surgical technique for placement of Proplast implant material to correct the deformity of the malunited zygomatic complex. Three cases are presented to illustrate this approach.

Custom fabricated silicone rubber implants for tissue augmentation--a review

Forty-five silicone rubber implants fabricated over a 13-year period for tissue augmentation in 44 patients were reviewed. All implants were custom-made with perforations using 382 RTV silicone elastomer. High rates of success and patient compatibility have been recorded.

Current status of biomaterial's clinical applications in plastic and reconstructive surgery

The use of biomaterials as replacement parts is not new. The concept has fascinated physicians for thousands of years. Using gold plates to reconstruct defects in the skull over 3000 years ago constituted the early record in the literature of use of biomaterials in implantology. The recent advances in space age technology and in clinical biocompatibility has been a major contributing factor in introducing new materials for use as implantology polymers. However, the ideal implant is still not there, and whenever a major reconstruction is required consideration should be given first to the use of autogenous substitutes; when that is not available, then we should resort to inorganic substitutes.

A simple trocar tor transcutaneous interosseous wiring in limited exposure sites

A simple trocar with inner canula is used in limited exposure sites for transcutaneous drilling. The trocar has an outer cannula which allows the special "air-powered" drill tip to pass through for transcutaneous interosseous drilling. No complications have been encountered by its use on numerous occasions.

Prefabricated silicone subdermal mandibular implants: observations and problems related to their application

Success in the use of custom-fabricated Silastic implants in patients with facial contour defects led us to utilize this method in reconstructing mandibular defects. However, mandibular reconstruction with alloplastic material is quite difficult because of the presence of continous stress and motion in that region. The evolution in the use in the use of the mandibular implant from the commercially available one to the K-wire reinforced, prefabricated, silicone implant was largely dependent on the availability of silicone and the ultimate result obtained. In the past few years, about 30 subdermal implants were inserted. Some of those implants were placed immediately into patients undergoing resection for tumor. The implant was prefabricated prior to surgery from x-ray measurements of the anticipated segment to be resected; it was then used to reconstruct the defect prior to the final closure of the operative wound. Other implants were manufactured 6-18 months after resection for tumor or for deformity as a result of trauma. The implants were used to reconstruct the facial defects and to correct the funtional abnormality, such as drooling or deviation of the affected side by the unstable mandibular segment. Patients with severe congenital malformation have soft tissue deficiency in association with their bony malformation. Therefore, implants in such conditions were doomed to failure. Patient selection is the key to successful implantation.