Single-stage Pinna Reconstruction in Thailand Experience

Background: Microtia reconstruction is one of the most challenging for the surgeon. In 1970, Brent modified Tanzer’s technique and became the foremost expert in microtia reconstruction with a 4-stage procedure. The most popular in Asia is Nagata from Japan, who developed Tanzer’s technique with 2-stage procedure. Reinisch has proposed to use porous polyethylene (PPE) (Medpor) in microtia reconstruction, and Romo also reported that using temporoparietal fascial flaps to surround the Medpor implant appears to have significantly reduced its failure. In Thailand, single-stage pinna reconstruction was experienced for more than 10 years, but no systematically demonstrated clinical outcome of this procedure. Objective: To study the clinical success rate and complication of single-stage pinna reconstruction in Thailand experience. Materials and methods: The data were recorded from 1 January 2009 to 31 December 2019 from every patient who underwent single-stage microtia reconstruction at Ramathibodi Hospital by a single surgeon (the author). A total of 81 patients were included in this study. Results: Male patients were 50 (62.5%) cases, and female patients were 30 (37.5%) cases. The mean age of the patient was 16 years old (range 1–59 years old). The majority of 78 cases (97.5%) were unilateral microtia reconstruction. About 67 cases (83.75%) underwent single-stage microtia reconstruction successfully without any complications. Only 13 (16.25%) cases had problems and some need solutions. There were 6 cases of early complications and 7 cases of late complications. In the early complication group, there was 1 case of hematoma and 5 cases of implant exposure. In the late complication group, all 7 patients encountered implant exposure problems. Among these patients, 5 patients needed only a single repair, and 2 patients had to undergo multiple surgeries. In our experience since 2009, only 1 patient was necessary to perform removal of prosthesis. Hence, our success rate of a single-stage microtia reconstruction using Medpor prosthesis has been 98.75%. Conclusion: Single-stage microtia reconstruction with porous high-density polyethylene implant is one of the safe and successful techniques to reconstruct microtia problems. The most advantages are that the procedure can be performed in a single procedure at younger age and lower morbidity, compared with costal cartilage uses. However, further study must be performed to decrease complications. In our experience, the successful rate is excellent.