Rib Autograft Versus Porous Polyethylene Implant Outcomes in Microtia Reconstruction: A Meta-Analysis and Systematic Review

Objective Auricular reconstruction for microtia typically involves autologous rib cartilage graft (ARCG) or porous polyethylene (PPE) implants. While ARCG is considered the gold standard, PPE has shown elimination of donor site morbidity. This meta-analysis compares outcomes between ARCG and PPE implants. Design A systematic search of literature from 2000 to 2023 identified 3463 studies. Cohorts and large case series comparing ARCG to PPE were included. Meta-analysis calculated pooled effect size differences in microtia reconstruction outcomes using a random-effects model. Main Outcome Measures Primary outcomes included infection rates, framework exposure, and redo procedures. Secondary outcomes assessed aesthetic results, patient satisfaction, and quality of life. Results Eleven studies met inclusion criteria, accounting for 3816 patients. Follow-up ranged from 30 days to 11 years for ARCG and 30 days to 8 years for PPE. Meta-analysis revealed that PPE had higher pooled infection, framework exposure, and redo operation rate differences of 3.18% (95% confidence interval [CI]: −2.00, 8.36%), 6.97% (95% CI: 0.07, 13.86%), and 4.88% (95% CI: −3.45, 13.20%), respectively. Moderate-to-significant heterogeneity was found ( I 2 = 39%-68%). Aesthetic outcomes and patient satisfaction varied, with 1 study reporting higher satisfaction with PPE (90% vs 47.1% for ARCG), while a larger study found greater satisfaction with ARCG (95.3% vs 82.7% for PPE). No significant differences were found in quality of life. Conclusion PPE implants may be associated with higher rates of infection, framework exposure, and redo procedures compared to ARCG. Poor study quality and heterogeneity highlight the need for further research comparing these techniques.