Any surgery can have complications. The key is finding a surgeon with the expertise to elegantly solve them.
First stage ear reconstructions for microtia and trauma
Revision surgeries for her own patients and for other surgeons’ patients
Salvage ear reconstructions for failed rib cartilage and failed Medpor
Learn below about the risks of Porous Implant Ear Reconstruction (PIER) and Dr. Lewin’s complication rates for 456 consecutive patients who had their 1st stage PIER surgery with Dr. Lewin over a 7-year period (2013 to 2019).
Any patients with previous ear surgery are not included.
Also shown are the complication rates of 167 consecutive patients who have received 1-piece implants (the Lewin Ear and 3D Lewin Ear implants by Su-Por).
An exposure occurs when part of the skin and tissue “flap” that covers the ear implant doesn’t survive, leaving a hole where the implant is visible. It is often mistakenly referred to as the body “rejecting the implant,” but in almost all cases, exposures are actually caused by unstable tissue covering the implant, not the implant itself. In most cases, an exposure REQUIRES SURGERY. This is truly where a surgeon’s level of experience can make the difference between a beautiful reconstruction and a disastrous outcome.
2-piece Medpor Implant exposure 2015
Exposure at top of ear
Repaired with flap and
small skin graft
2-piece Su-Por Implant exposure 2017
Exposure in middle of ear
Close up of exposed implant
Repaired with flap
1.5 years later
Fracture of Implant
2-piece Medpor or Su-Por implants are made from a thin helical rim and thick ear base (see image below) which are melted together to create the final form of the implant. Extra material is soldered between the two pieces to strengthen the implant, but any time a joint is made between two pieces, there is a weak point that can become stressed over time. Fractures almost always occur in the thin helical rim of the ear. There is some evidence to support fractures occur more frequently in patients who have canal reconstructions.
Helical rim and antihelical base
Appearance after the 2 pieces are melted together
The first sign is a change in the shape of the ear. Initially there is a “bend” or “crack” of the rim, which progresses to significant collapse of the ear over time as shown below.
Crack in the middle
of the rim
4 months later, complete
collapse of the ear implant
A fractured implant REQUIRES SURGERY because it must be removed and replaced. If not replaced, the rough edge of the fracture could erode the overlying tissue and lead to an exposure, making corrective surgery much more difficult. It is important to recognize that the risk of implant fracture increases over one’s lifetime due to daily “wear and tear” on the ear.
Fractured helical rim
1 month after implant
2 years after implant
The 1-piece LEWIN EAR IMPLANTS by Su-Por ELIMINATE the risk of FRACTURE since there are no weak areas when the implant is created from a single piece of porous polyethylene.
Infection is a rare but treatable complication of PIER surgery. Since the TPF fascial flap has a rich blood supply and integrates into the implant, infections respond very well to antibiotics. Patients take one week of oral antibiotics after surgery to prevent infection. If an infection does occur, it is usually between the first and second week after surgery.
After one week of
Bleeding is another rare post-operative complication. Bleeding can happen where the flap was removed (in the scalp) or where the skin grafts were taken (abdomen, arm or opposite ear). Bleeding rarely occurs on the new ear.
The facial nerve controls all the muscles of the face. Only one branch of this nerve is at risk for injury with PIER surgery, called the “frontal” or “temporal” branch. This nerve branch controls raising of the eyebrow on the side of surgery. Lowering of the eyebrow is not affected. Whenever possible, this branch is avoided by altering the flap design. On occasion, this is not possible, and a partial, temporary or permanent nerve injury can occur.
Flap Artery Injury
The TPF flap is a thin living membrane with arteries and veins that run through the fascia. Even very experienced microtia surgeons can inadvertently injure these critical blood vessels. If that occurs, the flap can still survive if the blood flow is reestablished by sewing the vessel back together. If this doesn’t work however, the ear reconstruction can fail and the ear may need to be removed and redone later.
Failure of Ear Reconstruction Surgery
The most serious risk of PIER is a failure of the surgery. If the flap is too thin, has a poor blood supply or the ear has an overwhelming infection that doesn’t improve with treatment, the implant must be removed. It is usually possible to perform another PIER surgery using a different “occipital” fascial flap after waiting 6 months to heal.