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Original Investigation |

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

Kristin K. Constantine, MD1; Jim Gilmore, MD1; Kenneth Lee, MD, PhD1; Joseph Leach Jr, MD1
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas
JAMA Facial Plast Surg. 2014;16(4):240-244. doi:10.1001/jamafacial.2014.30.
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Importance  Auricular reconstruction is a unique blend of cosmesis and functionality. The choice of the optimal framework material to use is an important decision for the patient with microtia.

Objective  To evaluate and compare the outcomes of reconstruction of microtia using porous polyethylene implants and rib cartilage grafts.

Design, Setting, and Participants  Retrospective medical record review from January 1, 2001, through December 31, 2012, at a tertiary academic institution. Thirty-five patients (36 ears) undergoing microtia repair were divided into groups using high-density porous polyethylene (17 ears), rib cartilage (17 ears), and both materials (2 ears). Only patients with completed repair were included in the analysis.

Exposures  Reconstructive surgery for microtia.

Main Outcome and Measures  We compared groups in terms of mean number of operations, age at treatment initiation, and complications (infection, extrusion, cartilage exposure, and pneumothorax). Photographs were graded by blinded observers to give each patient a score on protrusion, definition, shape, size, location, and color match.

Results  The cartilage group was older than the polyethylene group (mean age, 8.0 vs 6.9 years; P = .23). The mean number of operations was 4.88 for the cartilage group vs 3.35 for the polyethylene group (P = .004). Two patients in the polyethylene group had postoperative infections and implant extrusion and underwent subsequent reconstruction with cartilage grafts. Patients in the cartilage group had no infection or extrusion; 1 had a minor cartilage exposure. No patient had pneumothorax. Patients in the polyethylene group had significantly better grades for ear definition and size match, whereas those in the cartilage group had a significantly better color match. Patients in the cartilage group had better protrusion and location outcomes, although the difference was not significant.

Conclusions and Relevance  Comparison of reconstruction with porous polyethylene implants and rib cartilage grafts showed neither material to be clearly superior. Polyethylene implants may achieve a better cosmetic outcome in the categories of ear definition, shape, and size with a higher risk for infection and extrusion. Patients in the cartilage group were older and underwent significantly more surgical procedures, which should factor into the decision on which technique to choose.

Level of Evidence  3.

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