Porous Polyethylene Implant and Rib Cartilage in Ear Reconstruction: A Comparison

Abstract

Auricular reconstruction, known as the “surgical art,” is one of the most difficult and complex surgeries in medicine. There are two different techniques that involve either the use of artificial material like porous polyethylene (PE) or the patient's own rib cartilage graft. The patient's indication, age, conditions requiring previous failed surgeries, and the surgeon's skill in creating the frame are the most important factors in the choice of technique. Both methods are performed in our clinic in Vienna. We experienced more complications in the early cases using PE due to surgical inexperience. The advantages of PE, such as the fact that it is a single-stage surgery, favorable aesthetic appearance (definition and projection), and the possibility of combining the reconstruction with bone conduction devices or active middle ear implants and performing in older patients, can be compared with its disadvantages, such as greater complications. Both techniques require the acquisition of considerable skill and tricks, and for this reason it is important that a skilled surgeon who has mastered these auricular reconstruction skills is available to teach the next generation.

Keywords

rib cartilage - porous polyethylene - auricular reconstruction

• References

• 1 Tanzer RC. Microtia—a long-term follow-up of 44 reconstructed auricles. Plast Reconstr Surg 1978; 61 (2) 161-166
• 2 Rueckert F, Brown FE, Tanzer RC. Overview of experience of Tanzer's group with microtia. Clin Plast Surg 1990; 17 (2) 223-240
• 3 Brent B. Technical advances in ear reconstruction with autogenous rib cartilage grafts: personal experience with 1200 cases. Plast Reconstr Surg 1999; 104 (2) 319-334 , discussion 335–338
• 4 Brent B. Microtia repair with rib cartilage grafts: a review of personal experience with 1000 cases. Clin Plast Surg 2002; 29 (2) 257-271 , vii
• 5 Nagata S. A new method of total reconstruction of the auricle for microtia. Plast Reconstr Surg 1993; 92 (2) 187-201
• 6 Nagata S. Total auricular reconstruction with a three-dimensional costal cartilage framework. Ann Chir Plast Esthet 1995; 40 (4) 371-399 , discussion 400–403
• 7 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 (1) 35-47
• 8 Romo III T, Reitzen SD. Aesthetic microtia reconstruction with Medpor. Facial Plast Surg 2008; 24 (1) 120-128
• 9 Reinisch JF, Lewin S. Ear reconstruction using a porous polyethylene framework and temporoparietal fascia flap. Facial Plast Surg 2009; 25 (3) 181-189
• 10 Berghaus A, Stelter K, Naumann A, Hempel JM. Ear reconstruction with porous polyethylene implants. Adv Otorhinolaryngol 2010; 68: 53-64
• 11 Yang SL, Zheng JH, Ding Z, Liu QY, Mao GY, Jin YP. Combined fascial flap and expanded skin flap for enveloping Medpor framework in microtia reconstruction. Aesthetic Plast Surg 2009; 33 (4) 518-522
• 12 Constantine KK, Gilmore J, Lee K, Leach Jr J. Comparison of microtia reconstruction outcomes using rib cartilage vs porous polyethylene implant. JAMA Facial Plast Surg 2014; 16 (4) 240-244
• 13 Baluch N, Nagata S, Park C , et al. Auricular reconstruction for microtia: A review of available methods. [Review] Plast Surg (Oakv) 2014; 22 (1) 39-43
• 14 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 (4) 384-389
• 15 Hempel JM, Knöbl D, Berghaus A, Braun T. Prospective assessment of quality of life after auricular reconstruction with porous polyethylene [in German]. HNO 2014; 62 (8) 564-569
• 16 Romo III T, Presti PM, Yalamanchili HR. Medpor alternative for microtia repair. Facial Plast Surg Clin North Am 2006; 14 (2) 129-136 , vi