Reminder: Any child or adult who is born with Microtia does not have to have surgery if he/she does not wish to. If you like your little Microtia ear and would like to keep it just the way it is, you absolutely have the right and the choice to do so. However, if you believe that by having surgery, you will personally live a happier life, be able to wear glasses, be able to hear better through Atresia repair (canalplasty) if you are a candidate, and no longer be bullied, then of course surgery is an option that can help. A little Microtia ear should never be thought of as being “broken” and is not something that needs to be “fixed.” Microtia does not affect one’s intelligence, how you think, or what you would like to become in life. Surgery is always an option that can often times help improve self esteem and rescue an individual from depression depending on what they have experienced in life because of their little ear(s). Whether you are interested in having surgery or not, it is very important that you do your research and know what all of your choices and options are so that you can make the decision that is best for you.
I have decided not to label advantages and disadvantages for both the Rib Graft and Medpor techniques as they are both excellent options for ear reconstructive surgery. Surgical technique and medical advancements made in reconstructive surgery are always improving. What matters most, is that you have done your research, asked to see before and after pictures from at least a few different surgeons, speak with families who have already had surgery, and believe in the decision you make. When you feel comfortable with your research and the conversations you have had, then you will feel comfortable making a decision that is best for you or your child. Always stand by your decision and never criticize anyone for the decisions they have made. There is no right or wrong decision here, it is what you personally believe is the best decision for you.
Medpor Surgical Technique:
The Medpor surgical technique for ear reconstruction has been around for over 20 years. A Medpor ear is made up of a synthetic material consisting of a porous high-density polyethylene (PHDPE) that is then covered by a skin graft. The same Medpor material has been used in facial craniomaxillofacial surgeries for over 40 years. Although a Medpor framework is not made up of living tissue, such as the rib cartilage used in the Rib Graft technique, Medpor material does become vascularized as the blood vessels of the living tissue (skin graft) covering the ear weave throughout the porous holes within the synthetic framework. It has been noted, that when a Medpor ear is removed for repair, it “bleeds.”
The “Medpor Technique” was pioneered by Dr. John Reinisch (USA) in 1991. Dr. Reinisch has been utilizing Medpor for microtia exclusively for over 20 years with successful results. Medpor material has proven to hold up for at least 30 years (to date). Since the material is considered a “newer” material, it is quite possible that the material may last even longer than historical data proves. Medpor eliminates the additional stage required for harvesting rib cartilage used in rib graft procedures, including the elimination of an additional scar from where the rib graft is taken. Medpor surgery can be achieved in just one surgery stage. Sometimes, a second stage may be needed to fine tune the ear lobe.
Stage I: An incision is made by the Microtic ear where any malformed or excess cartilage is cut away and removed. Then, through the opening in the skin where the malformed ear cartilage has been removed, a section of skin called the tempero-parietal facia flap is then selected and cut out. The tempero-parietal fascia flap is a highly vascularized piece of tissue with a good blood supply. The pre-made Medpor framework is then carved and shaped with the use of a scalpel and heat to look like the other biological non-Microtic ear (if having bilateral Microtia, both ears will be shaped to look like one another and the size of the ear may be selected from one of the parents if the child resembles the same build).
Since the Medpor framework comes pre-made, the additional hours spent harvesting the rib, carving it, and stitching as done for a Rib Graft ear, are eliminated. The Medpor ear is still measured just like with a Rib Graft ear, so that the ear can be similar in size and shape to the already existing ear or non-Microtic ear. Once the framework for the ear has been shaped, the framework is then wrapped in the highly vascularized tempero-parietal fascia skin flap. A skin graft is then taken from the groin area (where no hair grows) and is then wrapped and stitched around the entire ear framework and the tempero-parietal fascia flap. This allows for the skin on the ear to not only remain vascularized, but this also allows for the two layers of skin to slide over each other making the ear feel more like a biological ear (where the skin moves separately over the framework). Often times, the skin graft and the tempero-parietal fascia skin flap that is used will have the hair follicles removed, if needed. Otherwise, the sections of skin selected for surgery are specifically taken from areas of the body where hair does not grow. If any hair is present it will be very fine, similar to lanugo (hair that is found on a new born following birth). The new ear is then completely sewn on to the skull (where the ear should be located and level with the other biological ear).
A Medpor ear is constructed to be slightly larger in size (around .5mm in size) than the already existing non-Microtic ear, allowing the biological (non-Microtic) ear to grow to the same approximated size of the newly reconstructed Medpor ear. The reason for this is because one can have Medpor surgery as early as 3 years of age and the other non-Microtic biological ear will continue to grow a little bit more, until age 5 or 6. A Medpor ear will be stiffer than the biological ear as the synthetic framework is a bit thicker than human ear cartilage, although the ear appears to physically be similar in thickness to the human eye. Since the Medpor ear becomes vascularized, the ear can feel pain, experience bleeding, and heal.
Duration of surgery: can range anywhere from 6 to 12 hours depending on the complexity of the surgery. Medpor is considered out patient surgery so no overnight hospital stay is required. A second stage may be required to tweak the earlobe if needed, which would also be considered out patient surgery. Bandages are typically removed between 1 to 2 weeks post op and the recovery time for Medpor surgery is fairly quick. Your surgeon will suggest you give the newly constructed ear a good 2 to 3 month period to heal along with no swimming (similar to Rib Graft). The younger a child is, the more resilient they are and less scaring will be visible as younger children tend to heal so well.
Note: The Medpor Technique can be achieved as early as three years of age.
Note: Medpor ears offer immediate projection and excellent definition.
Note: Medpor is favored among parents who are concerned about their children remembering any surgical trauma and being bullied in school. Since Medpor can be achieved at such an early age, these two concerns can be eliminated/prevented.