Reconstruction of the postauricular defects using retroauricular artery perforator-based island flaps

Abstract

The objectives of the study were to introduce and investigate the reliability of a new flap for postauricular defects using the retroauricular artery perforator.Twenty auricles from 10 Asian human cadavers were dissected to examine the retroauricular perforator distribution and diameter. Fourteen patients with postauricular defects underwent reconstruction using the retroauricular artery perforator from 2013 to 2015. After locating the position of the perforator by ultrasound Doppler blood flow detection, a suitable flap was designed according to the defect's size, condition, and distance from the pedicle. The flap was meticulously elevated, rotated appropriately, and sutured to the defect. The donor site was then closed.Cadaver dissection showed that the posterior auricular artery produces at least 2 constant branches with an external diameter of 0.84 ± 0.25 mm at the origin. These branches proceed toward the mastoid process at the height of the auriculocephalic angle to nourish the skin and fascia. A total of 14 clinical cases were available for 3 to 12 months postoperative follow-up. All flaps survived completely, maintaining good skin color, perfect outer contour, and complete patient satisfaction with the aesthetic results after initial treatment.Retroauricular artery perforator-based island flaps appear to be ideal for 1-stage reconstruction of postauricular skin defects.

Reconstruction of Small to Moderate Size Peri-Auricular Skin Defects Using Hatchet Flaps

“…In their study on a larger group of patients including fourteen patients with postauricular defects in a higher age group ranged from 55 to 75 years who underwent reconstruction using the retroauricular artery perforator flap This technique necessitate the use of ultrasound Doppler blood flow detection preoperatively, and the flap needs magnification loupe and meticulous dissection to avoid traumatizing, stretching, or kinking the perforator artery as the vessel is easily traumatized by perforator dissection. Another major disadvantage for this flap isthe venous congestion which occurred in the early postoperative period (A) (B) [5]. In hatchet flap technique, it is technically easy, with no need for preoperative imaging or use of magnification loupe to elevate the flap, in addition that we didn't experience any venous congestion in any of our study cases.…”

Surgical treatment of postauricular hidradenitis suppurativa with delayed diagnosis: a case report and literature review

“…In this case, we considered cosmetic factors when reconstructing the defect to ensure stable coverage without affecting the hairline. Therefore, we used a keystone flap based on a posterior auricular artery perforator for reconstruction [ 11 , 12 ]. The keystone flap is easy to perform and is suitable for reconstructing large areas while preserving the hairline [ 13 , 14 ].…”

Retroauricular Advancement Flap In Single Stage Auricular Defect Reconstruction

“…The importance of leaving the flap for at least two weeks before dividing and detaching it from the retroauricular skin is for adequate collateral revascularization, which is essential in preventing flap loss. 1,4,5 According to study of Worley et al 10 and Dessy et al, 11 retroauricular flap are recommended for auricular defect reconstruction surgery since it has good aesthetic outcome and no complication found in the patients. The study also explains the superiority of retroauricular flap over FTSG.…”

“…4 Retroauricular skin is an ideal skin flap bank for reconstruction of the anterior surface, the lobule, or occasionally the free margin in terms of the color, texture, relatively-relaxed and well-vascularized structure. 5 In this report, authors presented a case of auricular keloid caused by traffic injury with one stage of reconstruction using retroauricular advancement flap technique at dr. Cipto Mangunkusumo General Hospital, Jakarta.…”