AAPS Main SiteMedpor Ear Reconstruction: A Twenty-Three Year Experience with 1042 Ears
John F. Reinisch, MD, Wai-Yee Li, M.D. PhD.
Division of Plastic and Reconstructive Surgery, Keck School Of Medicine, University of Southern California, Los Angeles, CA, USA.
PURPOSE
Ear reconstruction is a notoriously challenging procedure. While the primary goal is a natural appearing ear, results with autologous rib cartilage are often sub-optimal. Medpor (high-density porous polyethylene) ear reconstruction gives a realistic-looking ear. Although it has become increasingly popular among parents of children with microtia, it has not gained widespread acceptance among reconstructive surgeons. We present the world’s largest series of Medpor ear reconstructions.
METHOD
We conducted a retrospective review of all patients who had undergone Medpor ear reconstruction, between 1991 and 2013. We recorded the history, gender, age at surgery, hospital stay and rates of infections, exposure and fracture.
RESULTS
A total of 1042 Medpor ear reconstructions were performed. There were 978 primary ear reconstructions for microtia (Figure 1). Of these cases, 301 were done with or after an ear canal reconstruction (Figure 2). An additional 59 were performed as a salvage procedure, following a failed or unsatisfactory ear reconstruction (Figure 3) and 5 were performed after trauma. The median age at the time of primary surgery was 4 years and 7 months, ranging from 2.5 to 59 years.
An early series (1993 - 1995) demonstrated high fracture and exposure rates of 25% and 44% respectively. With refinements of both the surgical technique and implant, the fracture rate has dropped to 1.5%. It was initially higher (8.7%-14%) when performed in patients with atresia repair. With implant modification, no fractures have occurred in the last 2.5 years. The current early exposure rate is 4%, with late exposure rate, (> one year post-surgery), less than 1%. Infection and hematoma rates are negligible. Since 1995, all but two surgeries have been performed as an outpatient. In the last four years, no post-operative drains have been used and 80% of microtia reconstructions were completed in a single-stage. Salvage or prior ear reconstructions using Medpor, covered by either a temporo-parietal or occipital artery fascial flap have been successful in all cases.
CONCLUSIONS
Medpor ear reconstruction has become increasingly popular for primary microtia patients. This single-stage technique gives a more realistic looking ear. It can be performed as an outpatient, before kindergarten and without a chest or scalp scar. The ability to perform simultaneous atresia and microtia repair is a further advantage in microtic children. As a salvage procedure, it is often the only acceptable reconstructive option, particularly in bilateral patients, who have had failed or esthetically unacceptable cartilage reconstruction.
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