Postauricular Fasciocutaneous Island Flap

B. GUYURON

H. P. LABANDTER

Dissatisfaction with the available modalities for eye socket reconstruction, particularly in an irradiated and previously operated field, prompted us to look for another alternative. Following much preplanning influenced by Washio’s work (1, 2), and after considerable cadaver dissections, clinical trials, and staged procedures, we came to the conclusion that a postauricular fasciocutaneous island flap can successfully be transferred for the correction of certain difficult defects (3).

INDICATIONS

The postauricular fasciocutaneous flap can be used for defects of the forehead, eye socket, lateral nose, cheeks, and commissure area. It can even be used for intraoral defects in the buccal sulcus area or the palatal region. An invaluable indication for this flap is the Treacher Collins syndrome, which usually represents a very difficult reconstructive challenge.

Hematoma, infection, partial flap loss, and injury to the temporalis branch of the facial nerve are all theoretical complications of this flap. However, in our experience, there were only two small superficial losses of the distal portions of the flaps, and both healed without further difficulties. The disadvantages of this flap include tedious dissection and a limited amount of available skin, which make it unsuitable for large defects. Occasionally, a split-thickness skin graft is needed to cover the donor-site defect.

This flap provides an adequate amount of skin and soft-tissue bulk for reconstruction of a missing eye socket and orbital area. The color match is close to the facial color for extended reconstruction. Being non-hair-bearing, the skin can be used to replace missing conjunctiva or mucosa. The donor defect can usually be closed primarily or with a small skin graft, which is usually not visible.

ANATOMY

Even though the useful cutaneous portion of the flap receives a random-pattern circulation from the posterior branch of the
superficial temporal vessel, the whole flap, including the triangular piece of dermis and the temporalis fascia, is raised as an island flap. Therefore, the arterial supply comes from the superficial temporal artery and the posterior branch of this vessel and then through the subdermal plexus reaching the cutaneous portion, which after passing through the capillary returns through the posterior branch to the superficial temporal vein.

FLAP DESIGN AND DIMENSIONS

This flap has three distinct anatomic components: the skin, dermis, and fascial portion, which encompasses the postauricular vessels. The cutaneous portion of the flap is the non-hair-bearing skin of the postauricular area. This portion can be as large as 5 × 6 cm. The dermis portion is a triangular-shaped area located cephalad to the upper pole of the helix at the base of the triangle positioned caudally (Fig. 30.1A). The base of this triangle is attached to the upper border of the postauricular skin to be transferred as a flap. This triangular deepithelialized area is approximately 6 cm long in a cephalocaudal direction, and it contains the posterior arterial and venous branches of the superficial temporal vessels. The third portion of the flap is the temporalis fascia just anterior to the triangular de-epithelialized skin of the scalp encompassing the superficial temporal artery and vein. This fascia is rectangular in shape, and its anterior boundary is about 5 to 10 mm anterior to the superficial temporal vessels. The posterior limits are de-epithelialized triangular skin, which extends cephalad up to 6 or 7 cm from the upper pole of the helix. The caudal limit is at the upper border of the zygoma, where it is often detached to allow freedom of movement for the vascular pedicle.

Only gold members can continue reading. Log In or Register to continue