Burn Ear Reconstruction Using Porous Polyethylene Implants and Tissue Expansion

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Abstract

Reconstruction of the external ear after a burn is particularly challenging. The nature of the injury poses many problems including excessive scar tissue, poor blood supply, and the lack of adequate and appropriate materials for a framework. The use of costochondral grafts often leads to marginal outcomes which do not justify the morbidity. Children under the age of 10 years commonly have insufficient cartilage for a graft. Medpor® (Stryker, Kalamazoo, MI) offers minimal morbidity and a very effective result. In this series, the authors describe the experience using Medpor® and scalp tissue expansion to reconstruct severely burned ears. A total of 16 pediatric patients underwent 18 reconstructions, with two patients receiving bilateral procedures. All patients received Medpor® implants. Thirteen patients were tissue expanded under the subgaleal plane before reconstruction, for concomitant scalp alopecia reconstruction. Eleven temporoparietal fascial flaps were performed. In the remaining patients, coverage of the implant was achieved by local advancement flaps. Only two patients had complications, with exposure of the construct after several years. In these two cases, the implants were removed. The experience has shown porous polyethylene reconstruction to be very efficient, with low morbidity and good cosmetic outcomes. Medpor® is an excellent option for the reconstruction of both fully and partially burned ears as you may implant only the helical rim, base, or both pieces. The best results were achieved after tissue expansion and the use of the alopecic skin overlying a temporoparietal fascial flap. This has become the preferred method.

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