The use of medpor as a projection block for the elevation of the constructed auricle in total auricular reconstruction

Abstract

The 2-stage methods of the total auricular reconstruction developed by Dr. Nagata have been widely used. In the second stage of ear reconstruction, the implanted auricle is separated from the underlying bed, and its posterior surface is covered with a skin graft or a flap. Many surgeons have used various projection blocks, such as banked cartilage or alloplastic materials, to provide the constructed auricle with adequate projection. Banked costal cartilage is most commonly used as a projection block, but it may not be possible to obtain banked cartilage in sufficient volume to ensure an acceptable projection. Previously, in this procedure, the author used a new fabricated cartilage block harvested from the fourth and fifth costal cartilages. Although this material is stable and yields acceptable results, an invasive and time-consuming procedure is necessary to obtain it. Therefore, the author considered the use of a Medpor (a high-density porous polyethylene, Stryker, USA) projection block as an alternative to the cartilage. Between January 2012 and May 2015, the author performed the second-stage operation by using a Medpor block in 51 patients. The follow-up period ranged from 1 year to 4 years. The use of a Medpor block for projection in the second stage is time-saving and less invasive. Delayed healing of the wound was noted in 2 cases, in which a deep temporal fascial flap, instead of a temporoparietal fascial flap, had been used for the coverage of the exposed framework. A hypertrophic scar was noted on the posteroinferior surface of the reconstructed ear in 1 case. However, no major complications such as infection or exposure occurred. The constructed ears showed a firm and stable projection.