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Long-Term Outcome of ePTFE Ear Reconstruction

 

Ear reconstruction for partially or completely removed/lost ears in adults must take into consideration the needed soft tissue coverage. While the cartilage of the ear can be replaced by either a synthetic framework or rib cartilage, it requires vascularized tissue and a skin graft to have a reconstruction result that survives and hopefully looks good. Contrary to the understandable perception of some patients, you can’t just put a skin graft directly on cartilage or a synthetic material.

In most cases of major ear reconstruction, the key element is what is known as a TPF flap. This stands for a temporoparietal fascial flap. Fed its blood supply by the ascending superficial temporal artery passing in front of the ear, this is the fascial layers (excluding the deep fascia) overlying the temporal muscle on the side of the head. This thin tissue can be raised off the entire temporal muscle and turned down to cover a synthetic or cartilage ear framework. It is onto this tissue that a skin graft can then be placed to complete the third layer of the reconstruction.

What is important for patients to understand is that healing of these complex ear reconstruction is a process. Right after surgery and for the first month or so the ear reconstruction often looks little like an ear. The tissues are swollen and distorted and it can just look like a swollen indistinct mass one the side of the head. It takes time for the swelling to goo down and, just as importantly, the overlying soft tissue coverage to shrink down and stick into all the details of the framework. Here is an example of a partial ear amputation due to skin cancer with an immediate ePTFE framework covered by a TPF flap and skin graft. It sort of looks like an ear at the end of surgery but will get quote swollen and distorted for weeks afterward.

When seen at three months after surgery, the ear looks more defined and some of the details of the framework can finally be seen. While it will never look exactly like what was removed, it creates an acceptable looking result.

The long-term aesthetic outcome of ear reconstruction awaits the contraction of the thin overlying vascularized tissues to adapt to the framework. This ‘shrink wrap’ effect is a process that takes months after the surgery to reveal its full effects.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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