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Vascularization strategies for porous polyethylene implants.

Porous polyethylene (pPE) is a frequently implanted biomaterial in craniofacial reconstructive surgery. Its rapid vascularization and tissue incorporation are major prerequisites to prevent complications, such as material infection, migration and extrusion. To achieve this, several sophisticated strategies have been introduced and evaluated during the last 20 years. These include i) the angiogenic stimulation of the host tissue with epidermal growth factor (EGF), basic fibroblast growth factor (bFGF) or macrophage-activating lipopeptide-2 (MALP-2), ii) material modifications, such as increase of surface roughness and incorporation of bioactive glass particles, iii) surface coatings with growth factors, glycoproteins, acrylic acid (AA), arginine-glycine-aspartic acid (RGD) peptide as well as components of the plasminogen activation system and autologous clotted blood or serum, and iv) the seeding with fibroblasts, chondrocytes, stem cells or adipose-tissue derived microvascular fragments (MVF). The majority of these approaches showed promising results in experimental studies and, thus, may be capable of improving the success rates after pPE implantation in future clinical practice.