Ear Reconstruction Using a Porous Polyethylene Framework and Temporoparietal Fascia Flap

Abstract

Ear reconstruction is a difficult procedure requiring a framework and soft tissue covering. The traditional method uses a rib cartilage framework placed beneath scalp skin. This method has been used for 50 years despite inherent problems with both harvesting rib cartilage and using scalp for coverage. The authors describe a method using a porous polyethylene (PPE) framework covered by a large temporoparietal fascia (TFP) flap raised with the underlying subgaleal fascia (SGF). The entire implant is covered by the two-layered flap, which can be raised without any scalp incision. The skin grafts applied to the covered implant lie on the SGF. The trilaminar structure of the SGF allows the skin to move independently over the implant, resisting shear forces and reducing the probability of implant exposure. Ear reconstruction using the PPE framework was performed on 786 ears over an 18-year period. Initial complications were common. With improved implant design and complete coverage of the implant with both the TPF and SGF, exposure rate dropped to 7% with a 12-year follow-up. Implant fractures decreased to less than 3%. The PPE/TPF method allows earlier ear reconstruction in children with minimal scarring and discomfort. The reconstructed ear can closely mimic the shape and projection of the natural contralateral ear in fewer stages and with a shorter learning curve.

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

“…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.…”

Reconstruction of Partial Auricular Defects by Polypropylene Mesh Helix Framework

“…Sengezer et al, 1996 mentioned three exposures in 10 ear reconstruction cases which were managed without implant removal [18]. Reinisch et al 2009 reported 7% exposure rate in ear reconstruction using Porous polyethylene framework was performed on 786 cars over an 18-year period [19]. Zhao et al 2009 reported that exposure of frame were 15 (1.07%) in 1485 autogenous graft cases autogenous graft while occurred in 48 (13.5%) cases MEDPOR ® alloplastic frame [9].…”

Porous polyethylene for the reconstruction of severe Cosman cleft ear deformities

“…An increasing number of surgeons use porous polyethylene as a framework for auricular reconstruction of both congenital and acquired defects [3,23]. Porous polyethylene is a synthetic thermoplastic with a pore size of 100-200 μm, thus allowing tissue ingrowth; it can be considered the most widely used alloplastic material for ear reconstruction [23,24].…”

“…The most widely used coverage of the porous polyethylene framework is a temporoparietal fascia flap [3]. However, in this case, we chose a postauricular fascia flap to cover the framework.…”