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Long-Term Surgical and Aesthetic Outcomes of Microtia Repair: Porous Polyethylene versus Autologous Costal Cartilage Reconstruction
Miriam Meghnagi^*, Jinggang Ng, Yuliia Kovach, Evrim E. Ozcan, Jonathan Sussman, Isabel Ryan, David Low, Jesse Taylor, Jordan W. Swanson, Scott Bartlett, Cassandra A. Ligh
Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA

Background:
The optimal reconstructive technique for microtia remains a subject of ongoing debate as surgeons search for a balance of structural integrity, aesthetics, safety, and patient satisfaction. We present our institution's long-term outcomes with autologous costal cartilage (ACC) and porous-polyethylene (PPE; e.g., Medpor, Supor) reconstruction. Additionally, we utilize layperson assessments to understand societal perception of aesthetic outcomes.
Methods:
A retrospective review was conducted of pediatric patients who underwent reconstruction for Marx grade III/IV microtia (2008-2023). Demographics, outcome data, and postoperative photos categorized as early (1-2 yrs) or late (>2 yrs) were collected.
Lateral-view photos were assessed in a survey using pairwise comparisons, analyzed with a Bradley-Terry model to rank ears from most to least aesthetically favorable. A second survey used deidentified frontal-view photos, asking participants to rate ear appearance on a 5-point scale (1=very poor; 5=excellent), analyzed using linear mixed-effects models.
Results:
84 ears were included (PPE, 52%; ACC, 48%). The PPE cohort underwent surgery at a younger age (8.4 vs 10.5 yrs, P=.005), with no difference in follow-up (3.8 vs 4.4 yrs, P=.453). PPE-reconstructed ears had higher rates of exposure (52.3% vs 27.5%, P=.021) and total explantation (20.5% vs 2.5%, P=.011).
Pairwise comparison of lateral photographs demonstrated higher aesthetic ratings for early PPE outcomes compared with ACC (P=.028). Late PPE outcomes trended higher but were not significant (P=.16). Frontal-view ratings did not differ between techniques (P=.473).
Conclusion:
Our findings highlight the trade-offs between complication risk and perceived aesthetics when selecting a reconstructive approach. Medpor/Supor was associated with higher complication rates while demonstrating superior early aesthetic outcomes when viewing the ear laterally. However, when evaluating from a frontal perspective, the more common social viewpoint, there were no significant differences between techniques at either timepoint.
Models adjusted for BMI, tissue expander size, and axillary irradiation. OR > 1 indicates higher odds with early exchange.

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