Porous polyethylene versus autologous costochondral reconstruction for microtia: incidence and analysis of secondary procedures.
Open accessAbstract
Objective To examine the frequency of autologous and alloplastic ear reconstructions for patients with microtia in the United States, and describe post-index procedure rates associated with each method. Design Retrospective cohort study. Setting Claims data from 500 + hospitals from IBM® MarketScan® Commercial and Multi-State Medicaid databases. Patients/Participants A total of 649 patients aged 1 to 17 years with International Classification of Diseases, ninth/tenth revision (ICD-9/10) diagnoses for microtia, congenital absence of the ear, or hemifacial microsomia. Interventions Alloplastic or autologous ear reconstruction between 2006 and 2018. Main Outcome Measure Post-index procedures performed within 1 year following the index repair, analyzed across the study period and separately for each half of the study period (2006-2012, 2012-2018). Results A total of 486 (75%) qualifying patients received autologous and 163 (25%) received alloplastic reconstruction. Secondary procedure rates were significantly higher in the autologous group at 90 days ( P = .034), 180 days ( P < .001), and at 365 days ( P < .001). Alloplastic reconstruction accounted for 23.2% of reconstructions in the first half of the study period compared with 26.7% in the second half ( P = .319). One-year secondary procedure rates in the autologous group were not significantly different between both halves of the study period (69.7% vs 67.1%, P = .558), but were significantly lower in the second half for the alloplastic group (44.9% vs 20.2%, P = .001). Conclusions In these databases, autologous reconstruction is more common than alloplastic reconstruction. Autologous reconstruction is staged, with most undergoing a secondary procedure between 3 months and 1 year postoperatively. Secondary procedure rates decreased over time in patients undergoing alloplastic reconstruction.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
R: A Language and Environment for Statistical Computing
R Core Team (2000) · doi:10.32614/r.manuals · Cited by 355,811 · see citing works
A new method of total reconstruction of the auricle for microtia
Nagata, S. (1993) · Plastic and Reconstructive Surgery · doi:10.1097/00006534-199308000-00001 · Cited by 640 · see citing works
TOTAL RECONSTRUCTION OF THE EXTERNAL EAR
Tanzer, R. C. (1959) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-195901000-00001 · Cited by 416 · see citing works
Auricular repair with autogenous rib cartilage grafts: two decades of experience with 600 cases.
Brent, B. (1992) · PubMed · Cited by 342 · see citing works
Auricular Repair with Autogenous Rib Cartilage Grafts
Brent, B. (1992) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-199209000-00001 · Cited by 333 · see citing works
The epidemiology of anotia and microtia.
Harris, J., Källén, B. A. J., & Robert, E. (1996) · Journal of Medical Genetics · doi:10.1136/jmg.33.10.809 · Cited by 246 · see citing works
Microtia repair with rib cartilage grafts
Brent, B. (2002) · Clinics in Plastic Surgery · doi:10.1016/s0094-1298(01)00013-x · Cited by 232 · see citing works
Auricular reconstruction for microtia: A review of available methods
Baluch, N., Nagata, S., Park, C., Wilkes, G. H., Reinisch, J. F., Kasrai, L., & Fisher, D. M. (2014) · Plastic Surgery · doi:10.1177/229255031402200102 · Cited by 151 · cited 1× · see citing works
“15, 16 It is also associated with less donor site morbidity and improved consistency with fi nal aesthetic results.”
BackgroundPrevalence Rates of Microtia in South America
Castilla, E. E., & Orioli, I. M. (1986) · International Journal of Epidemiology · doi:10.1093/ije/15.3.364 · Cited by 140 · see citing works
Auricular Reconstruction for Microtia: Part II. Surgical Techniques
Walton, R. L., & Beahm, E. K. (2002) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-200207000-00041 · Cited by 127 · cited 1× · see citing works
“7 7 – 13 Recently, technical changes allowing for single-stage reconstruction have also been described.”
BackgroundLi, D., Chin, W., Wu, J., Zhang, Q., Xu, F., Xu, Z., & Zhang, R. (2010) · Aesthetic Plastic Surgery · doi:10.1007/s00266-010-9502-1 · Cited by 122 · see citing works
Auricular reconstruction for microtia: A review of available methods.
Baluch, N., Nagata, S., Park, C., Wilkes, G. H., Reinisch, J. F., Kasrai, L., & Fisher, D. M. (2014) · Europe PMC (PubMed Central) · Cited by 100 · see citing works
Pre and post-operative psychological functioning in younger and older children with microtia
Johns, A. L., Lucash, R. E., Im, D. D., & Lewin, S. L. (2015) · Journal of Plastic, Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2014.12.019 · Cited by 99 · see citing works
Comparison of microtia reconstruction outcomes using rib cartilage vs porous polyethylene implant.
Constantine, K. K., Gilmore, J., Lee, K., & Leach, J. (2014) · JAMA Facial Plastic Surgery · doi:10.1001/jamafacial.2014.30 · Cited by 85 · see citing works
Medpor Alternative for Microtia Repair
Romo, T., Presti, P., & Yalamanchili, H. R. (2006) · Facial Plastic Surgery Clinics of North America · doi:10.1016/j.fsc.2006.01.006 · Cited by 70 · cited 1× · see citing works
“15, 18, 19 Several studies have reported on outcomes and complications of autologous and alloplastic reconstructions, though few direct comparisons have been made between the techniques.”
BackgroundCurrent Management of Microtia: A National Survey
Im, D. D., Paskhover, B., Staffenberg, D. A., & Jarrahy, R. (2013) · Aesthetic Plastic Surgery · doi:10.1007/s00266-012-0008-x · Cited by 66 · cited 1× · see citing works
“30 It is possible that lack of exposure to allo-plastic reconstruction in training contributes to a steep learning curve for alloplastic implant use in surgical practice, which may explain the fi nding that outcomes improved throughout the 12-year study period.”
BackgroundMarx, H. (1926) · Springer eBooks · doi:10.1007/978-3-642-92483-5_3 · Cited by 63 · see citing works
Long-term complications of microtia reconstruction: A systematic review
Ronde, E. M., Esposito, M., Lin, Y., van Etten‐Jamaludin, F. S., Bulstrode, N., & Breugem, C. C. (2021) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2021.08.001 · Cited by 55 · see citing works
Cabin, J. A., Bassiri‐Tehrani, M., Sclafani, A. P., & Romo, T. (2014) · Facial Plastic Surgery Clinics of North America · doi:10.1016/j.fsc.2014.07.004 · Cited by 52 · see citing works
Single-Stage Autologous Ear Reconstruction for Microtia
Kasrai, L., Snyder‐Warwick, A. K., & Fisher, D. M. (2014) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000000063 · Cited by 45 · cited 1× · see citing works
“14 The optimal age for reconstruction is between 7 and 10 years depending on the technique, to allow for adequate cartilage and soft tissue availability.”
BackgroundAuricular Reconstruction Using Porous Polyethylene Implant Technique
Stephan, S. J., & Reinisch, J. F. (2017) · Facial Plastic Surgery Clinics of North America · doi:10.1016/j.fsc.2017.09.009 · Cited by 45 · cited 1× · see citing works
“17 A variety of alloplastic materials have been trialed for use in auricular reconstruction since the early 20th century.”
BackgroundCurrent opinion on auricular reconstruction
Sivayoham, E., & Woolford, T. (2012) · Current Opinion in Otolaryngology & Head & Neck Surgery · doi:10.1097/moo.0b013e328355b1d9 · Cited by 44 · cited 1× · see citing works
“7 7 – 13 Recently, technical changes allowing for single-stage reconstruction have also been described.”
BackgroundPatient reported outcome measures in microtia surgery
Akter, F., Mennie, J. C., Stewart, K. J., & Bulstrode, N. (2016) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2016.10.023 · Cited by 44 · cited 1× · see citing works
“20 – 23 One study identi fi ed higher scores for auricle de fi nition, shape, size, and color in alloplastic reconstruction compared with autologous reconstruction.”
BackgroundRonde, E. M., Esposito, M., Lin, Y., van Etten-Jamaludin, F. S., Bulstrode, N. W., & Breugem, C. C. (2021) · Journal of Plastic, Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2021.08.004 · Cited by 38 · cited 1× · see citing works
“20 – 23 One study identi fi ed higher scores for auricle de fi nition, shape, size, and color in alloplastic reconstruction compared with autologous reconstruction.”
BackgroundOlshinka, A., Louis, M., & Truong, T. (2017) · Seminars in Plastic Surgery · doi:10.1055/s-0037-1603959 · Cited by 35 · cited 1× · see citing works
“8 Alloplastic reconstruction can be done in a single stage and at an earlier age than autologous reconstruction.”
BackgroundPatients' satisfaction after ear reconstruction with autologous rib cartilage
Kristiansen, M., Oberg, M. A., & Wikström, S. O. (2013) · Journal of Plastic Surgery and Hand Surgery · doi:10.3109/2000656x.2012.751027 · Cited by 34 · see citing works
Ear Reconstruction in Young Children
Reinisch, J. F. (2015) · Facial Plastic Surgery · doi:10.1055/s-0035-1568138 · Cited by 32 · cited 1× · see citing works
“25, 27 Because complication reporting for each technique is limited to these common concerns, which differ between autologous and alloplastic repair, few analyses have been done to evaluate the relative risks of each technique, including fi rst-year post-index procedures following both repair types.”
BackgroundPOLYETHELENE IN RECONSTRUCTIVE SURGERY
Rubin, L. R., Robertson, G. W., & Shapiro, R. N. (1948) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-194809000-00008 · Cited by 31 · cited 1× · see citing works
“15, 18, 19 Several studies have reported on outcomes and complications of autologous and alloplastic reconstructions, though few direct comparisons have been made between the techniques.”
BackgroundCuccolo, N. G., Zwierstra, M. J., Ibrahim, A. M. S., Peymani, A., Afshar, S., & Lin, S. J. (2019) · Plastic & Reconstructive Surgery Global Open · doi:10.1097/gox.0000000000002318 · Cited by 30 · see citing works
Zhang, G., Zhang, J., Liang, W., Chen, Y., & Ji, C. (2012) · International Journal of Pediatric Otorhinolaryngology · doi:10.1016/j.ijporl.2012.07.006 · Cited by 18 · see citing works
The History of Alloplastic Ear Reconstruction for Microtia
Kozusko, S. D., Konofaos, P., & Wallace, R. D. (2020) · Annals of Plastic Surgery · doi:10.1097/sap.0000000000002213 · Cited by 13 · cited 2× · see citing works
“15, 18, 19 Several studies have reported on outcomes and complications of autologous and alloplastic reconstructions, though few direct comparisons have been made between the techniques.”
BackgroundRisk Factors for Delayed Resorption of Costal Cartilage Framework Following Microtia Reconstruction
Kim, A., Park, H., Lee, H., & Oh, K. S. (2020) · Facial Plastic Surgery & Aesthetic Medicine · doi:10.1089/fpsam.2020.0144 · Cited by 10 · cited 1× · see citing works
“25, 26 Complications of alloplastic reconstruction include implant exposure, occurring in up to 30% of patients at 1 + year follow-up, as well as implant fractures.”
BackgroundBarone, A. A. L., Harris, T. G. W., Schroeder, M. J., Kennedy, C. L., Cooney, C. M. M., Ranganathan, K., Steinberg, J. P., & Redett, R. J. (2020) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2020.12.064 · Cited by 8 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [1]Marx H Die Missbildungen des ohres. In: Die Krankheiten Des Gehörorgans. Springer; 1926: 131– 169.
Cited by
Sorted by citations
Early Postoperative Complications in Microtia Reconstruction: An Analysis of the NSQIP‐P Database
Sharma, R. K., DeSisto, N. G., Ortiz, A. S., Landeen, K. C., Yang, S. F., Stephan, S. J., & Patel, P. N. (2023) · The Laryngoscope · doi:10.1002/lary.30989 · Cited by 12 · see citing works
“13,19,20 However, documented complication rates and comparison between reconstruction methods have been limited to small, low-impact studies.”
BackgroundMethodFinestone, S. A., Ortiz-Ocasio, L. S., Shetty, A., Boyarsky, B., Vu, S. L., Derdzakyan, N. A., Rana, M. S., Rogers, G. F., & Oh, A. K. (2025) · The Cleft Palate-Craniofacial Journal · doi:10.1177/10556656251349274 · Cited by 2 · see citing works
Willens, S. H., Alaniz, L., Humphrey, J., Shah, N., Antongiovanni, J., Mosieri, C. A., Jaffurs, D. C., Vyas, R. M., & Pfaff, M. J. (2025) · Plastic and Reconstructive Surgery, Global Open · doi:10.1097/gox.0000000000007355 · Cited by 1 · see citing works
“9,10 Although sensory input to the auricle is well described (Fig.”
Hu, K. G., Ihnat, J. M. H., Goss, J. A., Allam, O., Parikh, N., Salib, A., Aral, A. M., & Alperovich, M. A. (2025) · The Cleft Palate-Craniofacial Journal · doi:10.1177/10556656251324259 · Cited by 1 · see citing works
Single-Stage Autologous Microtia Reconstruction
Podolsky, D. J., Fisher, D. M., & Kasrai, L. (2025) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000011951
Antongiovanni, J. T., Mosieri, C. N., Waites, J., Hewett, S., Shah, N. D., Alaniz, L., Morphew, T., Blaine, K., Vyas, R. M., & Pfaff, M. J. (2026) · FACE · doi:10.1177/27325016261459571
Jobson, O., Ma, Y., Lloyd, M., & Hood, K. (2026) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000013393
- Authors
- Varagur, K., Zubovic, E., Skolnick, G. B., Buss, J., Snyder-Warwick, A., Reinisch, J., & Patel, K. B.
- Affiliations
- Washington University in St. Louis (US)
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA
- Cedars-Sinai Medical Center (US)
- Corresponding author
- Patel, Kamlesh B.
- Venue
- The Cleft Palate-Craniofacial Journal
- Publisher
- SAGE Publications
- Published
- 2022-10-11
- Volume
- 61
- Issue
- 3
- Pages
- 365-372
- ISSN
- 1055-6656 (ISSN-L)
- 1545-1569
- PMC
- PMC12329211
- OpenAlex
- W4304175889
- Cited by
- 7
- References
- 32
- Citations by year
- 2026: 2 · 2025: 4 · 2023: 1
- FWCI
- 1.19
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Cleft Palate-Craniofacial Journal (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Center for Advancing Translational Sciences (UL1 TR002345)
- Washington University Institute of Clinical and Translational Sciences Just-In-Time grant (720S)
- Agency for Healthcare Research and Quality (R24 HS19455)
- Topics
- Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
- Health Sciences › Medicine › Genetics › Congenital Ear and Nasal Anomalies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Craniofacial Disorders and Treatments
- Keywords
- microtia, ear reconstruction, porous polyethylene, alloplastic reconstruction, secondary procedures, hemifacial microsomia, pediatric patients, staged reconstruction
- MeSH terms
- Humans, Retrospective Studies, United States, Incidence, Porosity, Polyethylene, Congenital Microtia
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
