There are ample anastomoses between the superficial temporal artery and the retroauricular (postauricular) artery (Fig. 57.1A). By incorporating these two vessel systems in a temporal scalp flap, a flap has been designed that can be elevated without delay.

The superficial temporal and retroauricular arteries are identified with a Doppler flowmeter. Selection of points A, B, C, and D in Figure 57.1A is the key. Point A is the point around which the entire flap turns; it is a fixed point just in front of the anterior end of the helix and behind the superficial temporal artery.

The next step is the selection of point C. For the flap to reach a defect, line AC must be approximately half the length of the distance between point A and the defect. In an average-sized adult, the nose is about 14 cm away from point A. This means that for nasal reconstruction, line AC will have to be approximately 7 cm in length. To avoid injury to the superficial temporal artery and also to facilitate effective design of the flap, line AC is directed 10° to 15° posteriorly from an imaginary vertical line drawn through point A.

The selection of point B is important, since line AB forms the base of the pedicle. The length of line AB should be about 8 cm, and angle CAB should be about 60°. Ordinarily, one can select this point near to or at the hairline. Obviously, this is not possible in an individual who is bald or has a receding hairline.