Q: Dr. Eppley, Two years ago I got lateral supraorbital rim implants made of Medpor.There is only one design of supraorbital rim implants available from this company (Porex/Stryker). They were placed through the upper lid crease. About 4 weeks after surgery the implant on the left side got infected. The pus was drained through a small incision in the lid crease, the wound has been daily cleansed and I have been on Rifampicin and Ciprofloxacin for two months. Because of the incision for the draining, about 2 mm oft the implant surface became visible, but the hole closed soon after the infection subsided. Although since then I have never got any symptoms of infection like swelling, discharge, pus, warming or pain, there is still a quite visible red patch where the pus had been drained. This patch is 7 mm long and 3 mm broad and very adherent to the underlying implant surface… that means it doesn´t move with the upper eyelid. Fortunately it is no problem to close my eyelids. From time to time a thick layer of keratin forms on this patch. Do you think this could still be some kind of infection or could this be a chronic inflammation due to the mechanical friction? What would you advise me to do?
A: What you have is a healed sinus or fistula tract and the local sequelae when that occurs in thin tissue. When the implant was infected, the accumulated pus had to go somewhere and it usually goes to the path of least resistance. (along the incision line) This draining tract was a ‘hole’ in the tissues that, once the infection was resolved, collapsed and healed with scar tissue. This scar tissue is thinner and less stable than the normal eyelid tissues. This is why it is adherent, red and undergoes intermittent effort sat re-epithelization. (thick keratin patch)In short, this is not normal skin.
If this is bothersome what I would do is excise the scar, place a small fat graft underneath (to fill in the missing tissue and prevent recontracture of the skin down to the implant) and close the skin over it. This is a scar contracture issue not a chronic implant infection.
Dr. Barry Eppley