Aesthetic Microtia Reconstruction with Medpor

Abstract

The complex architecture of the auricle makes it one of the most challenging structures for the reconstructive surgeon to re-create. Overlying the ear's unique cartilage framework are layers of varied soft tissues forming a three-dimensional organ, which is distinctively positioned on the head. Arguably, the most challenging auricle to reconstruct is third-degree microtia due to a near-total absence of native tissue and a need for lifelong durability of the reconstruction. Many methods of reconstruction have been studied; autogenous costal cartilage reconstruction has been one of the more traditional methods, with favorable long-term results reported by several surgeons. However, this technique requires tremendous artistic and technical skill on the part of the surgeon-sculptor to construct a realistic-appearing ear. High-density porous polyethylene (Medpor) is a stable, alloplastic implant that can integrate with host tissues, is resistant to infection, and has been successfully applied to reconstruction of the head and neck. For auricular reconstruction, Medpor--enveloped in a temporoparietal fascial flap with full-thickness skin graft coverage--is a durable and aesthetically gratifying alternative in microtic patients. This alternative surgical technique reduces surgical time and morbidity, standardizes results among surgeons, and facilitates an aesthetic, natural-appearing reconstruction of the auricle.

Comparison of Microtia Reconstruction Outcomes Using Rib Cartilage vs Porous Polyethylene Implant

“…All patients were satisfied with the cosmetic appearance, and no major complication such as infection, extrusion, loss of implant, or flap necrosis was seen. Romo et al 9,10 continued to demonstrate good aesthetic results and reduced morbidity with polyethylene implants compared with cartilage grafts. Reinisch and Lewin 11 showed that ear reconstruction with porous polyethylene implants on 786 ears during an 18-year span had a rate of exposure of 7% and an implant fracture rate of 3% using a temporoparietal flap with underlying subgaleal fascia.…”

“…Since 2006, Romo et al, [8][9][10] Reinisch and Lewin, 11 Berghaus et al, 12 and Yang et al 13 have reported successful ear reconstruction using porous polyethylene as a substitute for rib cartilage. The polyethylene implant technique typically requires 2 or 3 stages spaced 4 months apart.…”

Porous Poly(vinyl alcohol)-Alginate Gel Hybrid Construct for Neocartilage Formation Using Human Nasoseptal Cells

“…High density porous polyethylene (HDPPE) has been extensively used for auricle and nasal reconstruction [2,3]. Although satisfactory results from reconstructive procedures using HDPPE can be achieved for nasal and auricle reconstruction, this is an inert inflexible material available in predetermined sizes and shapes and is predisposed to extrusion if implanted under a poorly vascularized environment.…”

Long-Term Morphological and Microarchitectural Stability of Tissue-Engineered, Patient-Specific AuriclesIn Vivo

“…1,2 Current clinical practice utilizes autologous costal cartilage to fabricate auricular facsimiles with longterm stability 3,4 ; however, this method is limited by donor-site morbidity, [3][4][5][6] a complex surgical sculpting process, [3][4][5]7 and differing mechanical properties compared to elastic auricular cartilage. 4,5 Alternatively, alloplastic implants produce predictable shapes and eliminate donor-site surgery, 3,8 but suffer from poor biocompatibility and high rates of infection and extrusion. 3,6 A tissue engineering approach to auricular reconstructions would overcome the limitations of both autologous and alloplastic contemporary treatments.…”