Porous Implant Ear Reconstruction (PIER)

An alternative to the Rib Cartilage technique for microtia treatment

Most of the world’s microtia surgeons use the rib cartilage technique for ear reconstruction. There is no doubt this technique has stood the test of time as a safe option for microtia treatment for over 50 years.

Most of the world’s microtia surgeons use the rib cartilage technique for ear reconstruction. There is no doubt this technique has stood the test of time as a safe option for microtia treatment for over 50 years.

BUT, just because most of the world USES RIB CARTILAGE doesn’t necessarily make it the best option.

BUT, just because most of the world USES RIB CARTILAGE doesn’t necessarily make it the best option.

If you are trying to decide what is best for you or your child, learn about the differences between these options.
If you are trying to decide what is best for you or your child, learn about the differences between these options.

Dr. Lewin believes there are 5 reasons why PIER is a better surgical option than Rib cartilage Ear Reconstruction.

Dr. Lewin believes there are 5 reasons why PIER is a better surgical option than Rib cartilage Ear Reconstruction.

1

Realistic Natural Appearance

The most important reason is the PIER technique creates the most similar appearance to the natural ear. In fact, the 3D LEWIN EAR IMPLANT by Su-Por (shown below) creates a mirror image to perfectly match the 3-dimensional anatomy of an individual’s natural ear.

This technology is not available with rib cartilage ear reconstruction or traditional Medpor implants, so these techniques cannot simulate the delicacy and 3 dimensionality of the natural ear.

Compare Dr. Lewin’s PIER outcomes using different implants in the gallery.

2

Only One Surgery

Dr. Lewin’s PIER technique creates a complete and symmetric ear in one operation.

Even patients with significant HEMIFACIAL MICROSOMIA can get a symmetric ear after just one surgery because the implant can be made to project as much as needed to match the opposite ear. Certain patients with difficult anatomy may benefit from a 2nd revision surgery.

 

In contrast, the rib cartilage technique creates an ear that lays flat against the head and requires 2-4 staged surgeries to complete the whole reconstruction. The ear is brought out from the head in the 2nd surgery by using rib cartilage or a porous polyethylene implant as a wedge behind the rib ear. Since it can be challenging to make a rib ear protrude like a normal ear, some rib cartilage surgeons choose to “pin back” the normal ear to try to achieve symmetry.

3

Completed Before School Age

Dr. Lewin offers surgery to children as young as 4 years old (the earliest age to safely perform elective surgery according to the latest pediatric anesthesia recommendations). The new ear can be completely healed before starting kindergarten.

Rib cartilage surgeons must delay surgery until 8-10 years of age to allow the ribcage to grow large enough to be able to make an ear. Waiting the additional 4 to 6 more years before getting a “big ear” may lead to psychological issues for young children dealing with microtia.

4

N Hospitalization

With PIER surgery, patients go home about an hour after surgery since there is minimal pain with this technique. By comparison, removing 3 rib cartilages is a painful process, so special IV medicines, pain pumps or an injection into the spinal canal (epidural injection) are required to control the pain. Patients having rib cartilage ear surgery must be admitted to the hospital for observation and pain management.

5

Avoids Chest Incision and Risk of Chest
Wall Deformity

Experienced surgeons using newer techniques in rib cartilage ear reconstruction have reduced the size of the scars on the chest and decreased the risk of chest wall deformities. However, this complication can still occur as seen above in a 12 year old girl with a failed rib ear who had a significant asymmetry of the left chest and breast.

Since ears are made from cartilage, it would seem that cartilage is the best solution for ear reconstruction...

But using rib cartilage in place of ear cartilage is like comparing apples to oranges.

RIBS and EARS are made from DIFFERENT TYPES of cartilage that have VERY DIFFERENT FUNCTIONS.

RIBS are are made of thick, strong HYALINE cartilage, which functions to protect our lungs and help the chest wall move as we breathe.

In contrast, EARS are made of delicate ELASTIC  cartilage, which has the special property of being extremely thin and flexible yet still able to maintain a 3-dimensional shape.

Those critical differences explain why a rib cartilage ear cannot achieve the detail and delicacy of a natural ear. If the rib cartilage framework was made as thin as an ear, the forces of scar tissue would completely distort the shape. In order to avoid this, the rib cartilage ear MUST BE MUCH THICKER AND FLATTER than a natural ear.

Ultimately, the most important decision IS NOT PIER vs Rib cartilage, but rather WHO you choose as your surgeon. The technique is only as good as the person performing it. DO YOUR RESEARCH and only go to someone who is a proven expert in ear reconstruction.