Microvascular Free Transfer of A Retroauricular Flap

EDITORIAL COMMENT

This chapter extends Washio’s technique of a pedicled retroauricular flap using microvascular techniques. The flap is a good one, but the anatomy is variable and therefore not always totally reliable.

A skin flap from the retroauricular area can be elevated on the posterior auricular vessels. The flap provides thin skin that matches facial skin in color and texture, with minimal donor-site deformities, and with the donor site easily hidden by hair. This flap has not been too widely used as a free flap, because the involved vessels are sometimes too small.

INDICATIONS

A retroauricular skin flap can be used in the treatment of medium-sized defects of the intraoral mucosa, nose, eyelid, and eye socket (1, 2-4). It can also be used to correct composite defects which include hair, such as skin defects in the hair-bearing area of the temporal hairline, preauricular sideburns, and upper eyelid-eyebrow region. The transitional zone from skin to hair can be naturally restored through the incorporation of hair in the flap, particularly when compared to conventional two-stage techniques (5).

ANATOMY

The retroauricular mastoid skin is supplied mainly by the posterior auricular artery (PA). This vessel usually branches off from the external carotid artery, and it ascends between the parotid gland and the styloid process of the temporal bone, to the groove between the cartilage of the auricle and the mastoid process. The PA supplies the skin located in the posterior aspect of the auricle. The posterior auricular vein does not always run along with the artery; instead, it may be located in a more superficial and posterior position vis-à-vis the artery. Anatomic variations of the posterior auricular vessels have been reported in the literature (4,6,7). The diameter of these vessels is sometimes too narrow for use in free-flap transfer (Fig. 64.1).

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