A Predictive Model for Size-Specific Temporoparietal Fascia Flap Planning in Porous Polyethylene-Based Auricular Reconstruction

Temporoparietal fascia (TPF) flaps are routinely harvested in a standardized size for auricular reconstruction using porous polyethylene implants, regardless of implant dimensions. This approach may lead to unnecessary over-dissection and increased morbidity, particularly in patients for whom a smaller implant is appropriate. The authors aimed to develop a predictive model for size-specific TPF flap planning based on implant dimensions. Commercially available "one-piece" porous polyethylene auricular implants, from 3 size categories ("small," "medium," and "large"), were analyzed. Using a pliable fabric to simulate TPF, the minimal flap size required to fully cover each implant was determined under standardized conditions. These empirical measurements were used to develop 2 multiple linear regression models to estimate the minimal flap length and width dimensions based on implant geometry. Measured flap dimensions increased proportionally with implant size. For all the implants, the required flap surface area exceeded the computer-modeled surface area. This is likely due to the curvature and folding of the fascia around the 3D framework. Linear regression analysis yielded 2 predictive formulas for estimating the minimal flap length and width dimensions based on implant dimensions. Preliminary clinical application of the model confirmed adequate intraoperative coverage. This study presents a practical tool for personalized preoperative flap planning in porous polyethylene auricular reconstruction. A size-specific approach to TPF flap harvest may reduce operative time and morbidity, while maintaining robust implant coverage.