Skin incision strategy in porous polyethylene-based microtia reconstruction: A novel subtype-specific algorithm.

BACKGROUND

In porous polyethylene (PPE)-based microtia reconstruction, achieving an esthetically contoured ear remains a surgical challenge owing to complex soft tissue placement and need for seamless skin coverage. Although autologous techniques have standardized incision patterns, no systematic approach exists for alloplastic procedures. We propose a subtype-specific skin incision algorithm for PPE-based microtia reconstruction to improve esthetic outcomes, standardize surgical planning, and evaluate clinical effectiveness.

METHODS

This analysis included 15 patients (16 ears) who underwent PPE-based auricular reconstruction between October 2023 and June 2024. Incision types were selected using a subtype-specific algorithm: midline incisions for grade 1-3 microtia and perimastoid incisions for grade 4 and bilateral cases. Adult and pediatric patients were assessed preoperatively and at 6 months postoperatively using the Glasgow Benefit Inventory (GBI) and Glasgow Children's Benefit Inventory (GCBI), respectively. All patients were evaluated using the Auricular Reconstruction Evaluation Scale at 6 months.

RESULTS

Among the 16 reconstructed ears, 9 and 7 underwent midline and perimastoid incisions, respectively. GBI and GCBI scores improved significantly postoperatively (p = 0.041 and p = 0.002, respectively). Preoperatively, GCBI scores were significantly lower than GBI scores (p = 0.002). The median evaluation scores included overall appearance (4.29 [IQR 4.17-4.43]), esthetic subunits (4.00 [IQR 3.95-4.20]), donor-site outcome (4.40 [IQR 4.20-4.60]), and psychosocial satisfaction (4.80 [IQR 4.70-4.90]).

CONCLUSIONS

The proposed incision algorithm improves esthetic and psychosocial outcomes in PPE-based microtia reconstruction by reducing the need for skin grafts and preserving postauricular sulcus depth, thereby offering a practical and reproducible strategy for surgical planning.

LEVEL OF EVIDENCE: Therapeutic, IV.