Postauricular and Retroauricular Scalping Flap (The Paras Flap)

EDITORIAL COMMENT

This would not be the editors’ first choice for donor tissue material, although the flap will survive on the axial blood supply.

The skin behind the ear and in the retroauricular region, although restricted in area, can be raised as an axial pattern flap with wide maneuverability. It provides a good skin match for the face without leaving any defect on the front of the face (1, 2, 3, 4, 5, 6).

INDICATIONS

This axial-pattern scalp flap with a random extension is an alternative choice for covering facial defects. The flap is easy to dissect and raise without prior delay. It can reach nearly the whole face and down to the hyoid bone on the contralateral side. The donor site is not visible from the front and, in profile, the skin-grafted area is covered by hair. The absence of any visible donor-site defect and an excellent color match are worth the possibility of a certain amount of morbidity in the postoperative period.

ANATOMY

There is a cross-communication between the frontal branches of the superficial temporal arteries, with the artery dividing into two branches: frontal and parietal. The frontal branch divides into two parts, one supplying the forehead and the other the hair-bearing scalp of the frontoparietal region. The forehead branch communicates with the ipsilateral frontal and bilateral supraorbital and trochlear vessels.

The main vessel of the flap is the posterior branch supplying the hair-bearing scalp. This is a constant vessel of about 1 mm in diameter running across the flap and beyond the midline up to the glabrous skin but not entering it. The postauricular and retroauricular scalping flap (PARAS) flap has a profuse circulation, primarily from the contralateral superficial temporal vessels, boosted by the postauricular and occipital vessels, the frontal branch of the ipsilateral superficial temporal vessels, and the bilateral supratrochlear and supraorbital vessels (Fig. 110.1).

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