Sclafani A P, Romo T, Silver L
Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary, N.Y., USA.
Plast Reconstr Surg. 1997 Jan;99(1):41-50. doi: 10.1097/00006534-199701000-00007.
Reconstruction in the head and neck is difficult and often requires complex solutions to restore functional and aesthetic form. While autogenous tissue is preferred, many alloplasts have been investigated. These materials, however, are foreign bodies, and most alloplasts tolerate exposure and infection poorly. An alloplast's in vivo behavior is a function not only of its composition but also of its form and macrostructure, as well as the interaction at the host-implant interface. Porous high-density polyethylene is well tolerated by surrounding tissue, and its porous core is rapidly infiltrated by host tissue. In order to further investigate the response of porous high-density polyethylene under adverse conditions, we implanted three porous high-density polyethylene disks and one silicone disk underneath the dorsal skin in each of 12 rats. The implants were exposed at differing times after implantation. After 7 days, the exposed areas were either skin grafted or allowed to close by secondary intention. Silicone implants all tolerated exposure poorly. Porous high-density polyethylene implants exposed soon after implantation also tolerated exposure poorly; however, none of these extruded. Porous high-density polyethylene implants exposed after the host tissue had invaded the pores tolerated exposure well, healing either by secondary intention or by skin grafting. Porous high-density polyethylene is a safe and reliable material for use in aesthetic and functional reconstruction of the head and neck. Porous high-density polyethylene and possibly other porous alloplasts tolerate exposure well once host fibrovascular tissue has invaded the implant pores. Further investigation of differing clinical settings and implant behavior is currently in progress.
头颈部重建手术难度较大，通常需要采用复杂的解决方案来恢复功能和美观形态。虽然自体组织是首选，但人们也对多种异体植入物进行了研究。然而，这些材料都是异物，大多数异体植入物对暴露和感染的耐受性较差。异体植入物在体内的行为不仅取决于其成分，还取决于其形状、宏观结构以及宿主与植入物界面处的相互作用。多孔高密度聚乙烯能被周围组织良好耐受，其多孔核心会迅速被宿主组织浸润。为了进一步研究多孔高密度聚乙烯在不利条件下的反应，我们在12只大鼠的每只大鼠背部皮肤下植入了三个多孔高密度聚乙烯圆盘和一个硅胶圆盘。植入物在植入后的不同时间暴露。7天后，对暴露区域进行植皮或任其通过二期愈合。硅胶植入物对暴露的耐受性都很差。植入后不久就暴露的多孔高密度聚乙烯植入物对暴露的耐受性也很差；然而，这些植入物均未挤出。宿主组织侵入孔隙后才暴露的多孔高密度聚乙烯植入物对暴露的耐受性良好，通过二期愈合或植皮实现愈合。多孔高密度聚乙烯是用于头颈部美学和功能重建的安全可靠材料。一旦宿主纤维血管组织侵入植入物孔隙，多孔高密度聚乙烯以及可能的其他多孔异体植入物对暴露的耐受性就会良好。目前正在对不同的临床情况和植入物行为进行进一步研究。
