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Semin Plast Surg 2017; 31(03): 161-172
DOI: 10.1055/s-0037-1604261
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Total Ear Reconstruction Using Porous Polyethylene

Kausar Ali
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Jeffrey G. Trost
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Tuan A. Truong
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Raymond J. Harshbarger III
2   Craniofacial and Pediatric Plastic Surgery, Dell Children's Medical Center, Austin, Texas
› Author Affiliations
Further Information

Publication History

Publication Date:
09 August 2017 (online)

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Abstract

Total ear reconstruction has been approached by several techniques involving autologous graft, prosthetic implant, and alloplastic implant options. Recent studies have shown the superiority of porous polyethylene (Medpor, Porex Surgical) reconstruction over autologous reconstruction based on improved aesthetic results, earlier age of intervention, shorter surgery times, fewer number of required procedures, and a simpler postoperative recovery process. A durable and permanent option for total ear reconstruction, like Medpor, can help alleviate the cosmetic concerns that patients with auricular deformities may be burdened with on a daily basis. In this article, the authors discuss the advantages of Medpor-based ear reconstruction and discuss recent advances in the surgical techniques involved, such as harvesting a temporoparietal fascia flap and full-thickness skin graft to adequately cover the Medpor framework and decrease extrusion rates.

Keywords

ear reconstruction - microtia - polyethylene - Medpor - temporoparietal fascia flap
 

  • References

  • 1 Hall III JW. Development of the ear and hearing. J Perinatol 2000; 20 (8 Pt 2): S12-S20
    CrossrefPubMedGoogle Scholar
  • 2 Eppley BL. Alloplastic implantation. Plast Reconstr Surg 1999; 104 (06) 1761-1783 , quiz 1784–1785
    CrossrefPubMedGoogle Scholar
  • 3 Tanzer RC. Total reconstruction of the auricle: a 10-year report. Plast Reconstr Surg 1967; 40 (06) 547-550
    CrossrefPubMedGoogle Scholar
  • 4 Brent B. Auricular repair with autogenous rib cartilage grafts: two decades of experience with 600 cases. Plast Reconstr Surg 1992; 90 (03) 355-374 , discussion 375–376
    CrossrefPubMedGoogle Scholar
  • 5 Nagata S. A new method of total reconstruction of the auricle for microtia. Plast Reconstr Surg 1993; 92 (02) 187-201
    CrossrefPubMedGoogle Scholar
  • 6 Firmin F. Ear reconstruction in cases of typical microtia. Personal experience based on 352 microtic ear corrections. Scand J Plast Reconstr Surg Hand Surg 1998; 32 (01) 35-47
    CrossrefPubMedGoogle Scholar
  • 7 Thorne CH. Ear reconstruction. In: Thorne CH. , ed. Grabb and Smith's Plastic Surgery. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2014: 283-295
    Google Scholar
  • 8 Bouhabel S, Arcand P, Saliba I. Congenital aural atresia: bone-anchored hearing aid vs. external auditory canal reconstruction. Int J Pediatr Otorhinolaryngol 2012; 76 (02) 272-277
    CrossrefPubMedGoogle Scholar
  • 9 Wilkes GH, Wong J, Guilfoyle R. Microtia reconstruction. Plast Reconstr Surg 2014; 134 (03) 464e-479e
    CrossrefPubMedGoogle Scholar
  • 10 Romo III T, Morris LG, Reitzen SD, Ghossaini SN, Wazen JJ, Kohan D. Reconstruction of congenital microtia-atresia: outcomes with the Medpor/bone-anchored hearing aid-approach. Ann Plast Surg 2009; 62 (04) 384-389
    CrossrefPubMedGoogle Scholar
  • 11 Evans AK, Kazahaya K. Canal atresia: “surgery or implantable hearing devices? The expert's question is revisited”. Int J Pediatr Otorhinolaryngol 2007; 71 (03) 367-374
    CrossrefPubMedGoogle Scholar
  • 12 Roberson Jr JB, Reinisch J, Colen TY, Lewin S. Atresia repair before microtia reconstruction: comparison of early with standard surgical timing. Otol Neurotol 2009; 30 (06) 771-776
    CrossrefPubMedGoogle Scholar
  • 13 Romo III T, Reitzen SD. Aesthetic microtia reconstruction with Medpor. Facial Plast Surg 2008; 24 (01) 120-128
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Bly RA, Bhrany AD, Murakami CS, Sie KC. Microtia reconstruction. Facial Plast Surg Clin North Am 2016; 24 (04) 577-591
    CrossrefPubMedGoogle Scholar
  • 15 Storck K, Staudenmaier R, Buchberger M. , et al. Total reconstruction of the auricle: our experiences on indications and recent techniques. BioMed Res Int 2014; 2014: 373286
    PubMedGoogle Scholar
  • 16 Thorne CH, Brecht LE, Bradley JP, Levine JP, Hammerschlag P, Longaker MT. Auricular reconstruction: indications for autogenous and prosthetic techniques. Plast Reconstr Surg 2001; 107 (05) 1241-1252
    CrossrefPubMedGoogle Scholar
  • 17 Cronin TD. Use of a silastic frame for total and subtotal reconstruction of the external ear: preliminary report. Plast Reconstr Surg 1966; 37 (05) 399-405
    CrossrefPubMedGoogle Scholar
  • 18 Berghaus A, Stelter K, Naumann A, Hempel JM. Ear reconstruction with porous polyethylene implants. Adv Otorhinolaryngol 2010; 68: 53-64
    PubMedGoogle Scholar
  • 19 Reinisch JF, Lewin S. Ear reconstruction using a porous polyethylene framework and temporoparietal fascia flap. Facial Plast Surg 2009; 25 (03) 181-189
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Adamson JE, Horton CE, Crawford HH. The growth pattern of the external ear. Plast Reconstr Surg 1965; 36 (04) 466-470
    CrossrefPubMedGoogle Scholar
  • 21 McKinnon BJ, Jahrsdoerfer RA. Congenital auricular atresia: update on options for intervention and timing of repair. Otolaryngol Clin North Am 2002; 35 (04) 877-890
    CrossrefPubMedGoogle Scholar
  • 22 Reinisch J. Ear reconstruction in young children. Facial Plast Surg 2015; 31 (06) 600-603
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Sclafani AP, Romo III T, Silver L. Clinical and histologic behavior of exposed porous high-density polyethylene implants. Plast Reconstr Surg 1997; 99 (01) 41-50
    CrossrefPubMedGoogle Scholar
  • 24 Frodel JL, Lee S. The use of high-density polyethylene implants in facial deformities. Arch Otolaryngol Head Neck Surg 1998; 124 (11) 1219-1223
    CrossrefPubMedGoogle Scholar
  • 25 Mohammadi S, Mohseni M, Eslami M, Arabzadeh H, Eslami M. Use of porous high-density polyethylene grafts in open rhinoplasty: no infectious complication seen in spreader and dorsal grafts. Head Face Med 2014; 10: 52
    CrossrefPubMedGoogle Scholar
  • 26 Niechajev I. Facial reconstruction using porous high-density polyethylene (Medpor): long-term results. Aesthetic Plast Surg 2012; 36 (04) 917-927
    CrossrefPubMedGoogle Scholar
  • 27 Pitanguy I, Ramos AS. The frontal branch of the facial nerve: the importance of its variations in face lifting. Plast Reconstr Surg 1966; 38 (04) 352-356
    CrossrefPubMedGoogle Scholar
  • 28 Helling ER, Okoro S, Kim II G, Wang PT. Endoscope-assisted temporoparietal fascia harvest for auricular reconstruction. Plast Reconstr Surg 2008; 121 (05) 1598-1605
    CrossrefPubMedGoogle Scholar
  • 29 Kludt NA, Vu H. Auricular reconstruction with prolonged tissue expansion and porous polyethylene implants. Ann Plast Surg 2014; 72 (Suppl. 01) S14-S17
    CrossrefPubMedGoogle Scholar
  • 30 O'Sullivan NA, Kobayashi S, Ranka MP. , et al. Adhesion and integration of tissue engineered cartilage to porous polyethylene for composite ear reconstruction. J Biomed Mater Res B Appl Biomater 2015; 103 (05) 983-991
    CrossrefPubMedGoogle Scholar
  • 31 Brent B. The team approach to treating the microtia atresia patient. Otolaryngol Clin North Am 2000; 33 (06) 1353-1365 , viii
    CrossrefPubMedGoogle Scholar
  • 32 Kim YS, Yun IS, Chung S. Salvage of ear framework exposure in total auricular reconstruction. Ann Plast Surg 2017; 78 (02) 178-183
    CrossrefPubMedGoogle Scholar
  • 33 Cenzi R, Farina A, Zuccarino L, Carinci F. Clinical outcome of 285 Medpor grafts used for craniofacial reconstruction. J Craniofac Surg 2005; 16 (04) 526-530
    CrossrefPubMedGoogle Scholar
  • 34 Braun T, Gratza S, Becker S. , et al. Auricular reconstruction with porous polyethylene frameworks: outcome and patient benefit in 65 children and adults. Plast Reconstr Surg 2010; 126 (04) 1201-1212
    CrossrefPubMedGoogle Scholar