Polyethylene Ear Reconstruction: A State-of-the-Art Surgical Technique

  • John F. ReinischEmail author
  • Youssef TahiriEmail author


The use of a porous high-density polyethylene (pHDPE) implant for ear reconstruction is gradually gaining acceptance because it allows for a pleasing ear reconstruction in young children before they enter school. In this chapter, we discuss the rationale behind the use of pHDPE for ear reconstruction, describe the steps of this challenging procedure, and answer the common questions that surgeons have when they come to observe the surgery, or when they go back to their respective practices and start performing this procedure. The key parts of this surgery are to meticulously harvest a well-vascularized superficial temporoparietal fascia (STPF) flap and to use appropriate color-matched skin grafts. This allows for a pleasing ear reconstruction with an excellent definition, projection, symmetry and long-term viability. The use of pHDPE with a thin STPF flap coverage is our preferred method of ear reconstruction since it can be performed at an earlier age, in a single stage, as an outpatient procedure with minimal discomfort and psychological trauma for the patients and parents.


Ear reconstruction Microtia Porous polyethylene implant 

Supplementary material

Video 6.1

(a) Harvesting the temporoparietal fascia flap through a single auricular incision (MP4 155236 kb)

Video 6.1

(b) Harvested TPF flap with healthy arterial pulsations (MOV 22785 kb)

Video 6.2

Carving of the porous high-density polyethylene implant (MP4 183159 kb)

Video 6.3

Shrink-wrapping of the STPF flap over the implant once the suction is applied (MOV 13463 kb)

Video 6.4

Full-thickness skin grafts are sutures over the STPF flap with 6-0 chromic catguts. These are single interrupted sutures that care close to each other. Adequate projection and definition is demonstrated in this video (MOV 67688 kb)

Video 6.5

Postoperative ear movements 1-year after surgery (M4V 23794 kb)


  1. 1.
    Tanzer R. Total reconstruction of the external ear. Plast Reconstr Surg Transplant Bull. 1959;23(1):1–15.CrossRefGoogle Scholar
  2. 2.
    Brent B. The correction of microtia with autgenous cartilage grafts: 1. The classic deformity? Plast Reconstr Surg. 1980;66(1):1–12.CrossRefGoogle Scholar
  3. 3.
    Nagata S, Fukuda O. A new reconstruction for the lobule type microtia. Jpn J Plast Reconstr Surg. 1987;7:689.Google Scholar
  4. 4.
    Firmin F. Ear reconstruction in cases of typical microtia: personal experience based on 352 microtic ear corrections. Scand J Plast Reconstr Surg Hand Surg. 1998;32(1):35–47.CrossRefGoogle Scholar
  5. 5.
    Ksrai L, Snyder-Warwick A, Fisher D. Single-stage autolog ous ear reconstruction for microtia. Plast Reconstr Surg. 2014;133(3):652–62.Google Scholar
  6. 6.
    Adamson J, Horton C, Crawford H. The growth pattern of the external ear. Plast Reconstr Surg. 1965;36(4):466–70.CrossRefGoogle Scholar
  7. 7.
    Tolhurst D, Carstens M, Greco R, et al. The surgical anatomy of the scalp. Plast Reconstr Surg. 1991;87(4):603–12; discussion 613–14.CrossRefGoogle Scholar
  8. 8.
    Klockars T, Rautio J. Embryology and epidemiology of microtia. Facial Plast Surg. 2009;25(3):145–8.CrossRefGoogle Scholar
  9. 9.
    Reed R, Hubbard M, Kesser BW. Is there a right ear advantage in congenital aural atresia? Otol Neurotol. 2016;37(10):1577–82.CrossRefGoogle Scholar
  10. 10.
    Kesser BW, Krook K, Gray LC. Impact of unilateral conductive hearing loss due to aural atresia on academic performance in children. Laryngoscope. 2013;123(9):2270–5.CrossRefGoogle Scholar
  11. 11.
    Jensen DR, Grames LM, Lieu JEC. Effects of aural atresia on speech development and learning. JAMA Otolaryngol Head Neck Surg. 2013;139(8):797–802.CrossRefGoogle Scholar
  12. 12.
    Kuppler K, Lewis M, Evans AK. A review of unilateral hearing loss and academic performance: is it time to reassess traditional dogmata? Int J Pediatr Otorhinolaryngol. 2013;77(5):617–22.CrossRefGoogle Scholar
  13. 13.
    Lieu JEC. Speech-language and educational consequences of unilateral hearing loss in children. Arch Otolaryngol Head Neck Surg. 2004;130(5):524–30.CrossRefGoogle Scholar
  14. 14.
    Lieu JEC, Tye-Murray N, Fu Q. Longitudinal study of children with unilateral hearing loss. Laryngoscope. 2012;122(9):2088–95.CrossRefGoogle Scholar
  15. 15.
    Jahrsdoerfer RA, Yeakley JW, Aguilar EA, Cole RR, Gray LC. Grading system for the selection of patients with congenital aural atresia. Am J Otol. 1992;13:6–12.PubMedGoogle Scholar
  16. 16.
    Roberson JBJ, Reinisch J, Colen TY, Lewin S. Atresia repair before microtia reconstruction: comparison of early with standard surgical timing. Otol Neurotol. 2009;30(6):771–6.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Keck School of MedicineUniversity of Souther CaliforniaLos AngelesUSA
  2. 2.Craniofacial and Pediatric Plastic SurgeryCedars Sinai Medical CenterLos AngelesUSA
  3. 3.Plastic and Reconstructive SurgeryCedars-Sinai Medical CenterLos AngelesUSA

Personalised recommendations