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Long-Term Outcomes and Early Lessons Learned of Polyethylene (Medpor) versus Autologous Ear Reconstruction at the Children's Hospital of Philadelphia
Jinggang Ng
*, Yuliia Kovach, Dustin Crystal, Alexander Wilson, Benjamin Massenburg, David Low, Jordan W. Swanson, Jesse A. Taylor, Scott Bartlett, Cassandra A. Ligh
Children's Hospital of Philadelphia, Philadelphia, PA
BackgroundPediatric microtia poses a challenge for surgeons who are faced with choosing the optimal technique. We examine our institution's early experience and evolution of technique with Medpor. We report the long-term outcomes of ear reconstruction with Medpor implant versus autologous rib cartilage.
MethodsA retrospective review was performed of children who underwent ear reconstruction from 2008 to 2023. Postoperative complications were graded using a modified Clavien-Dindo scale. Postoperative lateral and frontal photographs were assessed for ear definition, projection, size, and overall appearance in immediate (6 months to 1 year) and late (1 to 5 years) postoperative periods.
ResultsOne hundred patients were included, among whom 105 ears were reconstructed, with 48 (45.7%) using a Medpor implant and 57 (54.3%) utilizing autologous costal cartilage. Mean age at surgery was 7.3 ± 2.3 years in the Medpor cohort and 9.2 ± 1.9 years in the autologous cohort (p<.001). Mean postoperative follow-up was 2.5 ± 1.9 and 4.0 ± 3.4 years, respectively. Twenty-four (50%) and 24 (42.1%) patients experienced any complication in the Medpor and autologous cohorts, respectively (p=.419). Medpor-reconstructed ears were more likely to experience a higher-grade complication (3.6 ± 0.8 versus 3.0 ± 1.2, p=.041). Long-term aesthetic outcome data are currently being tabulated.
ConclusionMedpor facilitates an earlier reconstruction with minimal donor site morbidity in comparison to the autologous costal cartilage technique. While both techniques are associated with a high rate of complications, Medpor-reconstructed ears were more likely to be associated with higher-grade complications requiring surgical intervention. In our experience, the Medpor framework provides a more consistent aesthetic result with improved ear projection and definition, while autologous results vary depending on individual surgeon and level of experience. Additional data will provide insight on aesthetic outcomes of both modalities. The risk-benefit ratio of each surgical modality should be considered.
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