If you’re considering Medpor Ear Reconstruction for your child, you’ll hear or read various opinions from parents of children with Microtia, as well as on the websites of surgeons who treat Microtia patients. It’s easy to become confused! Here are some common myths to help you understand the Medpor Ear Reconstruction procedure.
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Medpor Myths FAQ
Fact: The Medpor ear implant is made from a synthetic material (porous polyethylene) that is designed to allow the body’s tissue to grow into the tiny pores of the implant. So, even though it is a foreign material, the body’s tissues integrate into the Medpor instead of building a wall around it the way most implants are walled off (like silicone).
Further, the body can’t “reject” something that is not living tissue, the way a kidney transplant can be rejected, for example.
However, if a hole in the skin covering the implant occurred and the Medpor became exposed, the body would be unable to heal over the hole. An “exposure” of the Medpor is uncommon, but generally is seen within six weeks after the initial surgery. A surgery would be required to fix this problem.
Fact: Porous polyethylene (Medpor) has actually been found to be extremely durable and safe for use in the body and has been used for ear reconstruction for over 20 years without adverse effects.
Fact: Medpor Ear Reconstruction traditionally required a large scalp scar to access the tissue under the scalp called the temporoparietal fascia (TPF) flap, which is used to completely cover the Medpor implant. The scalp incision caused a sizable scar with a visible area of hair loss when the hair was cut very short.
However, in 2006, Dr. Lewin developed a new, minimally invasive surgical technique to harvest the TPF flap with no scalp scars, eliminating the issues of visible hair loss. From the time she began performing this innovative technique, none of Dr. Lewin’s patients have required a scalp incision.
In a minority of patients, there may be small areas of hair loss of the scalp that may be temporary or permanent. This is more commonly seen in patients that have used a softband BAHA, which puts significant pressure on the scalp over years, in essence weakening this skin.
Myth: Since the Medpor ear is a pre-made implant, variations in the size, shape and projection of the child’s normal ear cannot be matched.
Fact: The Medpor framework is assembled from 2 standard pieces: a helical rim and an antihelical base. However, the base is always extensively modified to match the shape of the opposite ear, customizing details of the anatomy, creating shadows and highlights by carving into the implant.
The unique 2-piece design also allows Dr. Lewin to control the overall height and width of the ear by adjusting the length of the rim (shorter for a small or narrow ear, longer for a large or wide ear).
Finally, the base of the implant that sits against the skull is also modified to match the child’s anatomy, resulting in symmetric projection to the opposite ear. The projection can be matched with just one surgery, thus eliminating one of the surgical stages required in a Rib Graft Reconstruction.
Myth: The skin grafts used for Medpor ear reconstruction do not have the same color and sensation as normal ears.
Fact: If possible, the skin around the microtia remnant is used on top of the TPF flap to cover the front of the Medpor ear reconstruction. This is the exact same skin that is used to cover the rib cartilage framework and, therefore, should be an excellent color match to the opposite ear. If there is not enough skin to cover the entire front of the ear, skin from behind the normal ear is sometimes used as well.
Some patients do not have enough skin around the microtia remnant to be able to cover the front of the ear reconstruction, regardless of whether rib cartilage or Medpor techniques are used. This often occurs when a child has a low hairline. In this case, to get non-hair bearing skin, skin grafts must be taken from another area of the body, so the color match will not be as close as skin from the ear.
Right after surgery, the skin grafts used for the Medpor ear do not have sensation, but by 2 to 3 months after surgery, sensation starts to form on the new ear as nerves grow into the skin from the TPF flap underneath. This continues to improve for several more months, giving protective sensation to the new ear. The sensation of the Medpor ear reconstruction is not exactly the same as the normal ear.
Fact: It is true that once in place, the size of the Medpor implant does not change over time. Therefore, anatomic studies of how the ear grows are used to predict how large a child’s normal ear will get. The sizes of the parents’ ears are also taken into consideration. In this way, the final size is predicted and the Medpor ear is made to be that size.
Some microtia surgeons believe that rib cartilage ears continue to grow, but there is certainly no way to predict how much, or if, this will occur in any given child. Firm rib cartilage graft (that has no blood supply initially) is very different from delicate living ear cartilage, thus there is guesswork in all of these reconstructions.
It is critical to compare the reconstructed and normal ears to each other after surgery. Most microtia websites do not show views of the normal ear, thus there is no way to tell how similar the surgical ear is to the normal side. Dr. Lewin firmly believes all views of both ears at similar angles should be shown so families will have a realistic idea of how close the ears match. All of Dr. Lewin’s microtia patients have all views displayed in the Microtia Patient Gallery.
Any reconstructed ear can be injured by direct trauma, like a ball hitting the ear full force. That being said, trauma that injures a Medpor ear reconstruction is very rare. The flap that covers the ear is protective. Patients can have cuts or injuries to the ear that tend to heal without treatment or with just antibiotic ointment. One of Dr. Lewin’s patients fell against a metal ledge onto her Medpor ear reconstruction, causing a one inch long cut only three weeks after surgery. The cut was cleaned and “butterfly-taped,” and healed on its own with a barely visible scar.
A Medpor implant can fracture, however, and if that occurs it needs to be replaced with a simple surgical procedure. In early 2011, Dr. Lewin extensively modified the Medpor ear implant construction with a new technique to greatly increase the strength of the implant. Since this design change was implemented, no fractures have been seen in her patients.