Subtotal Ear Reconstruction with Alloplast

DISCUSSION

Subtotal ear reconstruction is a challenging surgical task that often requires non-traditional techniques. This particular patient was treated with an alloplastic implant and rib cartilage grafts. We utilized Medpor Helical Rim implant, a porous polyethylene material (Stryker, USA) used for microtia reconstruction. The implant was used for its elegantly curved helix. The rib cartilage was used to project the reconstructed ear away from the head. The magic, however, is in the TPF flap (temporoparietal fascia). Its robust blood supply arises in the superficial temporal artery. It is used to wrap the Medpor ear helix implant. A skin graft is placed on its outer surface. The thin nature of TPF flap shows the curvature of the implant while its great blood supply supports the skin graft. Two stages were required to achieve the desired results.

Fig. 1. Ear defect after cancer removal and TPF flap. Medpor ear implant. Ear implant in place with rib cartilage graft held with forceps.

Fig. 2. Skin graft in place. Next photo is before second stage refinement.

Fig. 3. Second stage refinement 4 months later. 6 weeks after second stage.