Auricular reconstruction with prolonged tissue expansion and porous polyethylene implants.

Abstract

This study aimed to present our clinical experience using a prolonged tissue expansion technique and a Medpor framework for congenital microtia reconstruction. Auricular reconstruction was performed in 3 surgical stages. In the first surgical stage, a 60-mL custom kidney-shaped tissue expander is placed subcutaneously in the retroauricular mastoid region. The tissue expander is then serially expanded to maximum volume plus 30%. The tissue expander is then left fully expanded for 3 to 6 months. In the second surgical stage, the tissue expander is removed and a single-piece Medpor implant is placed and covered entirely by the expanded skin flap, without application of a fascial flap or skin graft. In the third stage, we perform an excision of the remnant microtic ear. A total of 15 patients were included with postoperative follow-up ranging from 6 months to 5 years. The draped soft tissue envelope was thin enough to show the reconstructed ear with excellent definition of the framework. Complications in this series included 1 case of partial implant exposure. The use of a Medpor framework after prolonged tissue expansion provides a well-defined, well-projected ear with robust soft tissue coverage. The expanded skin envelope with this method provides sufficient retroauricular non-hair-bearing skin tissues for draping the framework without the need for temporoparietal fascial flap or skin grafting. This alternative surgical method reduces surgical time and morbidity, and facilitates an aesthetic, natural-appearing reconstruction of the auricle.