The role of alloplastic skeletal modification in the reconstruction of facial burns.

The external appearance of the face is largely dictated by its supporting facial skeleton. After an extensive thermal injury, the underlying facial skeleton may need to be either augmented or restored to maintain the functional and aesthetic appearance of the face. The factors that 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 of facial burn scars may be one of the greatest challenges for an implant material. We reviewed our experience with the use of the Medpor porous polyethylene implant in facial burn reconstruction. This biomaterial has structural characteristics that allow for tissue ingrowth, yet it resists deformation by contractile forces. A total of 57 consecutive implants were placed in 24 patients with facial burns. Implants were used for the chin, the nose, the malar region, and as an ear framework. Patient follow-up ranged from 6 months to 3 years. Although 4 implants became exposed and 1 was thought to become infected, only 1 of the implants was removed. There were no other implant-related complications. We believe that skeletal modification is an important step for a successful facial burn reconstruction. Porous polyethylene offers a promising solution for the complex reconstructive problem of using an alloplast in the environment of a facial burn.