Although there are many great resources on the internet to learn about MICROTIA EAR SURGERY, a lot of inaccurate information also exists. This is particularly true concerning Porous Implant Ear Reconstruction (PIER) using Medpor and Su-Por.
All of the following myths about PIER surgery are direct quotes taken from various microtia websites.
"Medpor is an artificial material and sooner or later will be rejected.”
The term “rejection” is frequently used when referring to Porous Implant Ear Reconstruction, but this term is not accurate. Scientifically, the body can only “reject” living tissue, such as a kidney transplant. Since the The PIER implant is made of porous polyethylene, it CANNOT be rejected. This synthetic material is considered foreign, but it is specifically designed to encourage blood vessels to grow into the pores (holes) of the implant. Most “so-called rejections” occur when the flap covering the porous implant (Medpor/Su-Por) has a problem. But if the living membrane flap is dissected properly by a surgeon with extensive experience, the PIER will be durable and stable.
"Minor trauma ...can cause an opening, increasing the risk of infections, exposing part of the Medpor implant, and ultimately resulting in complete extrusion and loss of the ear implant."
This statement is simply false. It comes from a poor understanding of how PIER surgery is performed. As long as the implant is completely covered with healthy vascular tissue (the “flap”), then the body integrates into the implant and protects the ear. All PIER ears will sustain minor trauma at some point, but they go on to heal. If a PIER ear gets an infection, it is treated with antibiotics like any other infection.
“The plastic framework can also break causing a tear in the skin with subsequent infection and ear loss.”
It is true that the traditional 2-piece Medpor or Su-Por implants can fracture because there are weak areas where the 2 pieces are melted together. But in Dr. Lewin’s entire career, she has never seen a fracture lead to a skin tear, infection and ear loss. The new one-piece Lewin Ear implants are created as a single intricate piece of Su-Por, and are therefore much stronger than the older style 2-piece implants, eliminating the risk of fracture. If a 2-piece implant does fracture, it can be replaced with a 3D Lewin Ear implant in a relatively simple surgery.
“Another problem with Medpor reconstructions is that they are covered completely with unfeeling skin graft.”
100% wrong! The beauty of the PIER technique is that the fascial flap that covers the implant has arteries, veins and nerves running through it. This living flap “gives life” to the skin on top of it, providing both blood supply and sensation to the skin grafts. Although PIER ears will never have the same sensitivity as a natural ear, children start to feel their new ears only weeks after surgery….watch Kyden feel his new ear for the first time:
“A large scar may be noticeable above the ear because of the flap obtained to cover the implant.”
This used to be true, and this is how I was taught in my Craniofacial Fellowship. But in 2006, one year after I finished my training, I developed a new way to retrieve the flap from under the scalp without leaving scalp scars. I have taught many other surgeons this technique hoping for it to become the standard of care. See the “proof”-- the very first patient to have a scarless flap:
“Another disadvantage of the MEDPOR polyethylene plastic framework is that it comes in one size and shape.”
Yes and no. The two pieces of the framework (the rim and the base) are the same for every patient, but the way they are soldered together allows the surgeon to change the size of the rim to better match the opposite ear. Now, with 3D Lewin Ear Implants, the ears are designed to be the PERFECT adult size and shape, providing a major advantage over the rib cartilage framework and the 2-piece Medpor implant.