Scars after total ear reconstruction with porous polyethylene:
the patients’ perspective
John Martin Hempel
Received: 1 October 2012 / Accepted: 20 March 2013 / Published online: 19 April 2013
Springer-Verlag Berlin Heidelberg 2013
Background Total ear reconstruction with porous polyethyl-
ene implants leads to three typical skin scars: a scalp scar from
harvesting the temporoparietal fascia flap as well as a groin
scar and a contralateral postauricular scar from harvesting full-
thickness skin grafts. This study evaluates the annoyance of
these scars from the patients’ perspective.
Methods Fifteen patients received structured questionnaires
covering the aesthetical outcome and daily impairment by
the three scar types, as well as validated questionnaires
measuring health-related quality of life.
Results The ear reconstruction had raised the health-related
quality of life in 14 patients. The scalp and groin scars were
rated “satisfactory,” and the postauricular scar was “good”
on an average. In contrast to the postauricular scar, the
annoyance by scalp and groin scars was substantial: Half
of the patients had sensation disorders on the scalp or groin.
The scalp scar impaired a third of the patients wearing a
desired hairstyle and the groin scar a third of the patients
wearing swimsuits. A fifth of the patients experienced feel-
ings of shame in the public due to the scalp and groin scars.
Conclusions While not preventing the beneficial effect of
ear reconstruction on patients’ health-related quality of life,
scalp and groin scars are annoying for a relevant percentage
of the patients. Therefore, the temporoparietal fascia flap
should be harvested with the smallest incision possible, full-
thickness skin grafts from the groin should be harvested as
small as possible, and harvesting areas for full-thickness
skin grafts other than the groin should be evaluated.
Level of Evidence: Level IV, therapeutic study.
Total ear reconstruction for microtia belongs to the most
challenging plastic operations, but, if carried out successful-
ly, leads to a considerable increase in the health-related
quality of life of affected children and adults . Although
there are numerous publications about the surgical details
and results of the different techniques for ear reconstruction,
only few studies focus on the patients’ perspective [1–4].
The subjective point of view, however, is of major impor-
tance in the evaluation of aesthetic operations .
For total ear reconstruction, the authors follow the con-
cepts of Berghaus  and Reinisch  using a porous
polyethylene framework covered by a temporoparietal fas-
cia flap and full-thickness skin. Postauricular skin from the
contralateral ear is used to cover the anterior side of the
reconstructed ear (except in cases of bilateral microtia),
since its thinness and color lead to an excellent cosmetic
appearance. The posterior side of the reconstructed ear is
covered by full-thickness skin grafts harvested from the
groin, which usually have a thicker structure and slightly
darker color. Thus, three typical skin scars result: a scalp
scar from harvesting the temporoparietal fascia flap (Fig. 1a)
as well as a groin scar and a contralateral postauricular scar
from harvesting full-thickness skin grafts (Fig. 1b, c).
Naturally, the reconstructed ear will be in the focus of
every postoperative evaluation. However, the authors noted
in a previous study that scars on the reconstructed ear, but
also on other locations, belonged to the most often named
J. M. Hempel
Department of Otorhinolaryngology, Head and Neck Surgery,
Ludwig Maximilian University, Munich, Germany
T. Braun (*)
Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde,
Marchioninistraße 15, 81377 München, Germany
Eur J Plast Surg (2013) 36:413–416