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Medpor Ear Surgery is a surgical technique to treat Microtia that uses a biocompatible polyethylene implant (Medpor) as a structural framework, which is then covered by the body’s own tissue to create an ear.
In 1982, Dr. Alexander Berkhaus recognized that porous polyethylene (commonly known as Medpor or Su-Por) is a tissue friendly, stable and infection-resistant framework material for use in ear reconstruction. Porous ear implants have been used in the U.S. since 1991. Over the past 10 years, the technique has become progressively more elegant and reliable. Although very few people in the world specialize in this technique, it has become the sole accepted surgical alternative to the more traditional option of Rib Cartilage Ear Reconstruction. Due to the technical expertise required to perform Microtia surgery, it is recommended that surgeons using this technique have extensive experience. As expected, results are optimized and complications are minimized when you choose a surgeon who performs the Medpor Technique on a regular basis.
One of the greatest advantages of Medpor Ear Reconstruction is that the surgery can be performed when a child turns 3 years of age, allowing for completion of the entire process well before the child enters kindergarten (even with bilateral Microtia).
Early reconstruction minimizes anxiety for the child as well as feelings of being “different.” There is another advantage of early completion of the surgery: the delicate, thin tissues used to cover the Medpor often show more definition in a 3 or 4-year-old than in older children or teenagers, who have thicker tissues.
In comparison to the Rib Cartilage surgery, the Medpor technique offers several other advantages: less pain, no inpatient hospitalization, fewer surgeries, lower cost, earlier restoration of hearing and, often, a more symmetric, natural-appearing ear.
Medpor is a biocompatible porous polyethylene material with a unique structure of interconnecting pores (or holes), which allows integration of the flap’s blood vessels into the implant. This quality protects the ear reconstruction, as the patient’s own vascularized tissue completely covers and integrates into the implant.
Medpor is the gold standard for the most non-reactive substance that can be used in the human body.
Over the past 20+ years, Medpor has been successfully used in over 250,000 cranial, oculoplastic, reconstructive and cosmetic surgeries.
 J. P. Rubin and M. J. Yaremchuk, “Complications and toxicities of implantable biomaterials used in facial reconstructive and aesthetic surgery: a comprehensive review of the literature,” Plastic and Reconstructive Surgery, vol. 100, no. 5, pp. 1336–1353, 1997.)
The Medpor implant comes as two individual pieces, which are then artfully sculpted and soldered together into a realistic framework to create a natural-appearing ear for your child. This 2-piece design allows your child’s surgeon to create an ear of any size and shape and, in the case of unilateral Microtia, to match the unique shape of the normal ear. Similarly, the amount of ear projection (distance of the ear from the head) can be easily controlled in order to match the other ear in the first operation, rather than adjusting projection in a subsequent procedure.
Unlike cartilage, the Medpor material is very strong, so details of the ear (like the rim) can be very delicate and thin while remaining strong enough to hold its shape. This property allows Medpor Ear Reconstructions to look very natural, and symmetric with the opposite ear.
Left, the Medpor implant as two standard pieces and, on the right, after customization.
The Medpor implant is 100% covered with a thin, vascularized “living” membrane called the Temporoparietal Fascia. We refer to it as a “TPF flap.” The entire key to success of Medpor surgery lies in the dissection of this flap. It is removed from under the scalp as a two-layered (bilaminar) membrane that envelops the implant. The deeper layer integrates into the Medpor while the superficial layer supports the skin that covers the new ear. Each of the two layers can move relative to one another, which protects the ear.
Once the flap is in place, it is covered with skin. There are several options to obtain the skin grafts, including the area around the Microtia, the opposite ear, the scalp, the lower abdomen/groin area, or the upper, inner arm.
One or two outpatient surgeries are performed.
If your child has bilateral Microtia (both ears), two or three surgeries are required.
Each child is unique in how they handle pain, but generally speaking, Medpor Ear Surgery is not very painful. Some children never require any pain medications, while others do experience discomfort. Most patients are prescribed Tylenol with Codeine for 1 to 3 days after surgery.
Many surgeons who perform the Rib Cartilage procedure believe it’s unsafe to perform ear reconstruction on children younger than 6 years of age. No doubt they believe that to be the case, but since the Rib Cartilage technique requires the child to be at least 6, these surgeons have never operated on a 3-year-old! By comparison, surgeons who specialize in Medpor Ear Reconstruction have performed hundreds of surgeries on 3-year-olds with no adverse affects.
Children are amazing! A little “tender loving care” goes a long way to help young children understand and cooperate with the postoperative course. The ear is also well protected with a dressing, so there is little harm that can be done.
Watch 3-year-old Neabella go through Medpor surgery:
Anthropometric studies of the growth of a human ear show that at 3 years old, the length of the ear is 80% of normal adult size. By 6 years of age, the ear is 90% adult length. Therefore, based on the child’s age, the size of the opposite ear, and the size of the parents’ ears, the final adult size is estimated by your child’s surgeon, and an appropriately sized implant is made.
Right after surgery, the Medpor ear is very swollen and the skin grafts are purple and pink. The ear is protected with a cup for 3 weeks. The ear takes on its final shape at around 6 months after the 1st stage surgery. After that point, no specific long-term care of the ear is required beyond cleaning periodically.
Medpor has been successfully used in surgical reconstruction for over 30 years. To date, the Medpor ear implants have been well accepted by the body with no evidence of deterioration. However, since the ear implants have only been in use for 25 years, the stability over one’s lifetime cannot be established.
Ear reconstruction won’t limit your child from pursuing the activities he or she enjoys. Your child may go back to normal activities 6 weeks after surgery, including all sports. As with any child playing a sport, appropriate protective equipment for the particular sport (helmets for biking, baseball, football, lacrosse, hockey, etc) should always be worn. Many children with Medpor Ear Reconstructions have gone on to play competitive sports as they grew older.
Several months after the initial surgery, your child will develop sensation in the Medpor ear. The sensation comes from the “living membrane” flap that is used to cover the implant. The sensation will never be exactly the same as a normal ear, however.
The flap covering the Medpor implant has a rich blood supply, which allows it to heal from the typical bumps, cuts and bruises your child will experience. However, if a direct force hits a Medpor ear, there certainly could be injury to the reconstruction. Another reason to wear a helmet when engaging in sports!
Yes, the Medpor can fracture. If this happens, an outpatient surgery is required to remove the old implant and replace it with a new implant. In early 2011, Dr. Lewin changed the way she constructed the Medpor implant to significantly increase the strength of the implant. Since that time, no fractures have been seen in any of her patients.
Yes. Many patients have had successful “redo” Medpor ear surgery. Under rare circumstances, a Medpor ear reconstruction may fail due to a significant problem with the flap that cannot be repaired. If this occurs, the Medpor must be removed, and the body allowed to heal for 6 months. Another Medpor ear reconstruction is then performed using a different flap adjacent to the original flap.
Any surgical ear reconstruction cannot look as natural as a “normal” ear. The most notable difference is that both Medpor and Rib Cartilage ear reconstructions cannot bend the way a natural ear does, since the framework needs to be strong to resist the forces of scar formation.