The Postauricular Ultrathin Skin Flap And The Subcutaneous Tissue Flap: Anatomical Studies And Clinical Application In One-stage Total Ear Reconstruction

Total auricular reconstruction is important to repair the microtia deformity.It is one of the greatest technical feats that a plastic surgeon may encounter.Many innovative proceders of total ear reconstruction have been reported in the recent literature. Today, the most frequently performed are derived from Tanzers multiple-stage procedures and Songs one-stage procedure.The latter is to place a carved rib cartilage framework between a postauricular ultrathin skin flap and a subcutaneous fascia tissue flap to complete total ear reconstruction in a single operation.However,the anatomical bases of the two flaps of Songs one-stage procedure have not been very clear.Also,the long-term result is unknow.It is the purpose of this study to know the vascular basis of the two flaps,and to review the long-term results.The postauricular cutaneous tissue of 15 fresh Chinese cadevers were dissected under 3~6×loupe magnification after injection of colored latex through bilateral common carotid arteries and internal jugular veins(red in arteries,blue in veins).The findings of this anatomic study were as follows.(l)The blood vessels of mastoid skin was a stratiform system,which is formed by the superficial networks and the deep networks.The superficial blood vessels networks,which was the subdermal plexus, was composed of the perforators of the posterior auricular artery (PAA),and the postauricular branches of the superior auricular artery(SAA) ,and the branches to the auriculomastoid skin from the arterial distribution of the postauricular artery.The deep networks was composed of the occipital branch of the PAA.(2)Besides the anterior auricular branches,the SAA,which posteriorly from the superficial temporal artery(STA), had another two important branches: the postauricular branch and the communicational branch.The former measured 0.48 to 0.84mm(average 0.58mm) in diameter. (3)The PAA ascended between the auricular cartilage and mastoid process,dividing into auricular and occipital branches.There were 3 to 4 auricular branches, and each of them distributed a branch to the auriculomastoid area.The postauricular branches masured 0.4 to 0.7mm(average 0.6mm)in diameter.(4)The occipital branches distributed several perforators which perforated subcutaneous tissue to subdermis.and then scattered and...