Wrapping hydroxyapatite implants

Hydroxyapatite (HA) implants currently are most commonly wrapped in fresh unprocessed human donor sclera before implantation to facilitate entry into the orbital space and allow extraocular muscle attachment. Autologous temporalis fascia or autologous fascia lata are alternatives, but prolong surgery time and require a second operative site. Recently, a number of other wraps, such as processed human pericardium, processed human fascia lata, processed human sclera, bovine pericardium and expanded polytetrafluoroethylene [e-PTFE], have being marketed. Although they also facilitate implant placement, they can be costly. Polygalactin (Vicryl, Ethicon, Somerville, NJ) mesh is another readily available wrap that is easy to use and cost effective. To obtain a high success rate with this wrap, the polygalactin mesh wrapped HA implant must be moistened and seated into the orbit properly. If it is not, exposure may occur, which may explain why some surgeons shy away from its use. The proper technique is reviewed in this paper.