Long-Term Outcomes with Porous Polyethylene Implant Reconstruction of Large Craniofacial Defects

Background Porous polyethylene (PP) has been used in craniofacial reconstruction but has been primarily relegated to small and moderate size defects. This series evaluates the long-term outcomes after alloplastic reconstruction of cranial defects larger than 5 cm using PP implants. Methods Eighteen patients who had reconstruction of large cranial defects, owing to tumor resection or trauma, using PP implants, with at least 2 years of postoperative follow-up, were included in the study. If soft tissue coverage was inadequate, tissue expansion was planned before final cranioplasty. Results The frontal region was the most common area reconstructed (n = 10). Four patients required tissue expansion owing to soft tissue deficit. The major complication observed was implant exposure, seen in 3 patients (15%). Two of these healed with local wound care; 1 required removal of the implant. A statistically significant difference in risk of implant exposure was observed when tissue expansion was employed in reconstruction (P = 0.001). Conclusions This study confirms the material's low rate of infection and extrusion even in large craniofacial defects. Its neuroprotection properties are comparable with other first line alloplastic materials used for cranioplasty. Moreover, it can be shaped as required, there is no resorption with time and no concern for donor site morbidity. The higher exposure rate, in cases in which tissue expansion was also used, was owing to the poor quality of the soft tissue overlying the defect. These qualities make it an attractive option in alloplastic cranioplasty.