Comparative Outcomes Of Autologous Vs Synthetic Ear Reconstruction: A Multi- institutional Analysis With 10-year Follow Up

Purpose: Ear reconstruction remains one of the most technically challenging procedures in pediatric plastic surgery. A successful reconstruction achieves an aesthetically pleasing result with adequate vascularity and low complication rates. The traditional method employs autologous costal cartilage, which is associated with high durability and lower infection rates but carries donor-site risks including pneumothorax and chest wall deformities. Synthetic frameworks, such as porous polyethylene, offer more predictable aesthetic outcomes, but have been reported to carry higher risks of infection and extrusion. Existing literature is limited to single-institution cohorts with short-term follow-up. To date, no multi-institutional analyses have directly compared outcomes of autologous vs synthetic ear reconstruction. The objective of this study was to evaluate the use of autologous vs synthetic frameworks for ear reconstruction with up to 10 years of follow-up. Methods: This multi-institutional retrospective cohort study utilized the TriNetX Research Network, a federated database of 100 healthcare organizations in the United States. Patients undergoing ear reconstruction with autologous or synthetic materials were identified, and propensity score matching was performed on demographics and comorbidities, yielding two cohorts of 2,771 patients each. Outcomes were evaluated from 2 weeks to 10 years postoperatively, including revision, removal, infection, dehiscence, post-procedural sequelae, device/graft-related complications, infection, and dehiscence. Measures of association included risk difference (RD), risk ratio (RR), odds ratio (OR), and hazard ratio (HR) with 95% confidence intervals. Kaplan-Meier survival analyses with log-rank testing assessed long-term outcomes. Results: At 10 years, there were no significant differences in revision, removal, post-procedural sequelae, device/graft-related complications, infection, and dehiscence rates between autologous and synthetic reconstructions up to 10- years post-operatively. Revision rates were similar between autologous (1.98%) and synthetic (2.13%) reconstructions (OR 0.93, 95% CI 0.64-1.35). Removal rates were identical (1.15%; OR 1.00, 95% CI 0.61-1.64). Post-procedural sequelae occurred in 6.13% of autologous and 6.89% of synthetic reconstructions (OR 0.88, 95% CI 0.713-1.093). Device/graft-related complication rates were 2.56% for autologous and 2.74% for synthetic reconstructions (OR 0.93, 95% CI 0.67-1.29). Infection (OR 0.99, 95% CI 0.72-1.36) and dehiscence (OR 1.17, 95% CI 0.79-1.73) rates were also similar. Kaplan-Meier survival analysis demonstrated equivalent long-term event-free survival (log-rank χ²=0.101, p=0.75). Overall survival probability at 10 years was 97.4% for autologous and 97.2% for synthetic reconstruction. Conclusions: Contrary to prior studies suggesting increased complication rates with synthetic frameworks, this multi-institutional retrospective study demonstrated no significant differences in long-term revision, removal, and complication rates between autologous and synthetic reconstructions. Our findings support widespread safe use of synthetic frameworks such as porous polyethylene in ear reconstruction, broadening reconstructive options for both surgeons and patients in the surgical decision-making process. *Source: https://ps-rc.org/meeting/Program/2026/23.cgi*