Common nose implant has high infection rate: study

NEW YORK Mon Aug 27, 2012 4:18pm EDT

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NEW YORK (Reuters Health) - Nose jobs done with a common type of plastic implant may have a higher complication rate than previously thought, researchers said Monday.

As many as one in five nose jobs using Medpor, a product made from porous high-density polyethylene, led to infections in a new study. And in nearly all of those cases, the implant eventually started poking out through the surgical wound.

"The infection rate was extremely high and startling," said Dr. Andrew Winkler, a plastic surgeon at the University of Colorado in Denver, who led the study. "There are still situations where you may consider Medpor, but you need to weigh the pros and cons carefully."

By contrast, there were no complications when surgeons grafted tissues from the patients' own bodies, such as nose, ear or rib cartilage.

Porex Technologies, the manufacturer of Medpor, did not return phone calls or emails requesting comment.

Winkler and his colleagues, whose study is the largest of its kind so far, went through medical records for 659 patients who had had nose jobs for cosmetic or reconstructive purposes.

Three surgeons at the Oregon Health and Sciences University in Portland carried out all of the procedures, most of which were done without artificial implants.

Medpor or Gore-Tex - the two most common nose implants in the U.S. - were used in 151 cases (the material in Gore-Tex is known as expanded polytetrafluoroethylene, or ePTFE).

According to the study, published in Archives of Facial Plastic Surgery, there were 19 infections in total, and all of them occurred with the plastic implants. In all but one of these cases, the implant began protruding through the skin.

Winkler said grafting the patient's cartilage is the best solution, but might not always be practical. With Gore-Tex, he and his colleagues found an infection rate of five percent, compared to 19 percent with Medpor.

That suggests Gore-Tex is fairly safe, as found in earlier studies, said Winkler. But Gore-Tex and Medpor are used for different purposes - one is soft and the other is stiff - so they are not interchangeable.

"The infection rate was even higher than I would have expected," said Dr. Jeffrey Spiegel, chief of facial plastic and reconstructive surgery at Boston Medical Center.

And when artificial implants get infected, he added, giving antibiotics often is not enough. Instead, the implants will have to be taken out, leading to another surgery.

Spiegel, who was not involved with the new study, said using the patient's own cartilage from the body is usually possible, although it takes longer than using a plastic implant. Harvesting that cartilage comes with its own risk of complications, but Spiegel said it is minimal.

"I just don't see it," he told Reuters Health.

Another expert argued that the new study overestimates complications from nose jobs, also called rhinoplasty.

That's because it includes revision surgeries, in which the nose tissue has already been damaged and so is more likely to get infected, said Dr. Thomas Romo, director of facial plastic and reconstructive surgery at Lenox Hill Hospital in New York City.

In his 21 years of experience with Medpor, he said the rate of infections was "very low" in first-time nose jobs.

But even after accounting for such revision surgeries, Winkler's team still found a much higher risk of infection in patients who had plastic implants, particularly Medpor.

"Whenever you are undergoing a rhinoplasty, make sure you have a very frank conversation with your surgeon," concluded Winkler. "There are always pros and cons."

SOURCE: bit.ly/RSGWCC Archives of Facial Plastic Surgery, online August 27, 2012.

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