Retroauricular flap: its clinical application and safety

Auricular Reconstruction

The auricle is susceptible to various injuries due to its location and projection from the scalp. The unique contours of the external ear makes reconstruction a challenging endeavor. This chapter provides a comprehensive overview of auricular reconstruction, based on the depth, location, and size of injury. Strategies for reconstructing superficial, composite, and full-thickness injuries are discussed in relation to the location of the defect. Targeted reconstructive options for injuries of the upper, middle, and lower thirds of the auricle are outlined. Methods for total auricular reconstruction and auricular prosthesis are discussed. Options for managing traumatic injuries are reviewed, including avulsion/amputation injuries, burns, electrical injuries, frostbite, and human/animal bites. This chapter provides a practical framework for surgeons faced with complex auricular defects, offering insights to recreate a discreet, harmonious ear.

External Ear Melanoma Treated with Auricular Reconstruction Using Four Different Tissues in a 16-Year-Old Patient

The auricular region is a common site of cutaneous malignancies, most of which are nonmelanoma skin cancers, such as basal cell carcinoma and squamous cell carcinoma, in older patients. They are often treated with limited surgery that can be performed under local anesthesia. We report the case of a young patient with external ear melanoma who underwent reconstruction for defects of more than one-half of the helix and concha using four types of tissues: a rib cartilage graft, temporoparietal fascia flap, full-thickness skin graft, and retroauricular flap. Extending the retroauricular flap posteriorly to the entire hairless area allowed us to cover the anterior surface of the rib cartilage framework, which helped effectively achieve aesthetics. In auricle reconstruction, it is crucial to determine how well the anterior surface of the auricle is created.

Rhomboid Flap Reconstruction for Type 1 Postauricular Variant of Preauricular Sinus

Preauricular sinuses are common congenital malformations in paediatric patients. We describe a case of preauricular sinus with postauricular extension, a "variant type" of pre-auricular sinus and its management. After control of infection with antibiotics, the sinus was excised in toto using bidirectional approach. The sinus tract along with rim of conchal cartilage and post auricular skin was excised. The defect was reconstructed using retroauricular rhomboid flap. At one month follow up, the post-operative wound showed no signs of infection, minimal scar formation and had satisfactory aesthetic outcome. This reconstruction technique can be considered in cases of defects in posterior pinna.

A successful reconstruction of the upper antihelix defect via postauricular pull-through pedicle flap

The auricle is a complex anatomic structure with a three-dimensional configuration proper reinstating that poses a substantial reconstructive challenge. The postauricular pull-through flap is perfectly suitable method for the reconstruction of helical and antihelical auricle defects; however, due to its difficult harvest technique, it is not commonly used in a practice. Here we describe a case of a patient with an antihelix defect following basal cell carcinoma (BCC). In our case, the reconstruction was performed via postauricular pull-through pedicle flap, and a satisfactory result was achieved.

Sideburn Reconstruction Using a Pre-Expanded Island Scalp Flap Based on the Parietal Branch of Superficial Temporal Vessels

ABSTRACT

Sideburns are crucial for head and face esthetics. Absence of sideburns is associated with physical and psychological consequences. Many methods have been described for sideburn reconstruction; however, characteristics of the ideal method include optimal vascularization, ideal hair density, natural hair growth, and facial symmetry with minimum donor-site morbidity. In this study, the authors describe a novel method of sideburn reconstruction using a pre-expanded island scalp flap based on the parietal branch of the superficial temporal artery. Between February 2012 and December 2020, 9 patients underwent sideburn reconstruction surgery that involved 2 stages. During the first stage, an appropriately sized tissue expander was inserted underneath the scalp. After sufficient inflation of the expander, at the second stage, an island scalp flap based on the parietal branch of the superficial temporal vessels was elevated to reconstruct the sideburns. The mean size of the defects was 8 × 4.4 cm (range, 6 × 3-12 × 5 cm), whereas the average flap dimension was 10.22 × 5.67 cm (range, 8 × 4-13 × 8 cm). All flaps survived completely without any perfusion-related complications. Patients were followed up after surgery, ranging from 4 to 34 months (mean, 15.67 months). All patients and/or their parents were satisfied with the final appearance in terms of hair density, hair growth direction, and facial symmetry. Although a 2-stage procedure, this novel technique allows the reconstruction of a new sideburn with natural growth and orientation of the hair and minimal morbidity for patients.

Using the Reversed Temporal Island Flap to Cover Small Forehead Defects from Titanium Mesh Exposure After Cranial Reconstruction

BACKGROUND

Skin ulcers and alloplastic implant exposure are intractable complications that arise after cranial defect reconstruction. Many methods have been used to repair these defects, including skin grafting, local flaps, and free flaps; however, in most cases, alloplastic implants must be removed to control infections. Here, we describe the use of a reversed temporal island flap to repair exposed titanium mesh without removing it.

METHODS

Eight cases of skin and titanium mesh exposure were included from 2010 to 2015. A preauricular flap pedicled on the reversed superficial temporal artery was designed to repair forehead defects. The titanium mesh was retained, resterilized, and reimplanted.

RESULTS

Flaps were survived completely, and the titanium meshes were reimplanted with no complications. The results were aesthetically and functionally sufficient, with minimal donor-site morbidity in all cases during the 10- to 24-month follow-up period.

CONCLUSIONS

The described method is easy to design and perform. The flap has a reliable blood supply to help fight infection. The titanium mesh is preserved completely, avoiding a second cranioplasty.

A Simplified Reconstructive Technique for Full-thickness Central Defects of the Auricle with the Use of a Post-auricular Folded Flap

BACKGROUND

Post-auricular flaps have proved very effective in the reconstruction of most types of partial auricular defects. However, few reports exist regarding the reconstruction of centrally located perforating defects of the auricle.

OBJECTIVES

This paper aimed to describe a one-stage technique including a post-auricular folded flap (PAFF) for reconstruction of full-thickness defects of central auricular sites.

PATIENTS AND METHODS

Between March 2010 and November 2014, five male patients were treated with this reconstructive technique under local anaesthesia. At the time of surgery, patients' age ranged from 76 to 86 years (mean age, 79.8). The patients suffered from a central and full-thickness defect owing to surgical excision of a skin malignancy or failed reconstruction procedures secondary to surgical excision of a skin malignancy.

RESULTS

Healing was uneventful for all the included patients, without signs of dehiscence, necrosis, hematoma and infection. The defects were completely repaired, without the need of further operations. During the follow-up period, all the patients remained satisfied with the aesthetic outcome.

CONCLUSIONS

This technique constitutes an immediate, effective and low-morbidity procedure to repair full-thickness central defects of the auricle. Since PAFF requires only one surgical operation under local anaesthesia, patients with burdened medical history may profit from this technique.

Vascular mapping of the retroauricular skin - proposal for a posterior superior surgical incision for transcutaneous bone-conduction hearing implants

BACKGROUND

Passive transcutaneous osseointegrated hearing implant systems have become increasingly popular more recently. The area over the implant is vulnerable due to vibration and pressure from the externally worn sound processor. Good perfusion and neural integrity has the potential to reduce complications. The authors' objective was to determine the ideal surgical exposure to maintain perfusion and neural integrity and decrease surgical time as a result of reduced bleeding.

METHODS

The vascular anatomy of the temporal-parietal soft tissue was examined in a total of 50 subjects. Imaging diagnostics included magnetic resonance angiography in 12 and Doppler ultrasound in 25 healthy subjects to reveal the arterial network. Cadaver dissection of 13 subjects formed the control group. The prevalence of the arteries were statistically analyzed with sector analysis in the surgically relevant area.

RESULTS

The main arterial branches of this region could be well identified with each method. Statistical analysis showed that the arterial pattern was similar in all subjects. The prevalence of major arteries is low in the upper posterior area though large in proximity to the auricle region.

CONCLUSIONS

Diverse methods indicate the advantages of a posterior superior incision because the major arteries and nerves are at less risk of damage and best preserved. Although injury to these structures is rare, when it occurs, the distal flow is compromised and the peri-implant area is left intact. Hand-held Doppler is efficient and cost-effective in finding the best position for incision, if necessary, in subjects with a history of surgical stress to the retroauricular skin.

TRIAL REGISTRATION

This was a non-interventional study.

The postauricular fasciocutaneous flap with an adipofascial extension: A case report

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The postauricular flap has never been used with an adipofascial extension.

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We present a case with an ear defect covered with this flap.

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The indications and blood supply of the flap are discussed.

Introduction

A complex defect on the anterior surface of the ear requires flap cover; such as the postauricular skin flap. The postauricular skin flap has never been used with an adipofascial extension.

Presentation of case

A 5-year old boy was involved in a car accident resulting in an exposed cartilage of the upper part of the right ear. The defect was covered with a post-auricular fasciocutaneous flap with an adipofascial extension. The adipofascial part of the flap was covered with a skin graft.

Discussion

The adipofascial extension serves two purposes: Firstly, it allows easier primary closure of the donor site. Secondly, it is less bulky and hence it does not observe the definition of the ear cartilage.

Conclusion

Our case is the first case reported in literature using the post-auricular fasciocutaneous flap with an adipofascial extension.

Reconstruction of the postauricular defects using retroauricular artery perforator-based island flaps: Anatomical study and clinical report

The objectives of the study were to introduce and investigate the reliability of a new flap for postauricular defects using the retroauricular artery perforator.Twenty auricles from 10 Asian human cadavers were dissected to examine the retroauricular perforator distribution and diameter. Fourteen patients with postauricular defects underwent reconstruction using the retroauricular artery perforator from 2013 to 2015. After locating the position of the perforator by ultrasound Doppler blood flow detection, a suitable flap was designed according to the defect's size, condition, and distance from the pedicle. The flap was meticulously elevated, rotated appropriately, and sutured to the defect. The donor site was then closed.Cadaver dissection showed that the posterior auricular artery produces at least 2 constant branches with an external diameter of 0.84 ± 0.25 mm at the origin. These branches proceed toward the mastoid process at the height of the auriculocephalic angle to nourish the skin and fascia. A total of 14 clinical cases were available for 3 to 12 months postoperative follow-up. All flaps survived completely, maintaining good skin color, perfect outer contour, and complete patient satisfaction with the aesthetic results after initial treatment.Retroauricular artery perforator-based island flaps appear to be ideal for 1-stage reconstruction of postauricular skin defects.

Aesthetic correction of severe cicatricial upper-eyelid ectropion with a retrograde postauricular island flap

BACKGROUND

Cicatricial ectropion of the upper eyelid is a serious problem because of the association with exposure keratitis and ulceration. Traditional surgical treatment usually requires skin grafts or local flaps depending on the severity of the defect. However, outcomes have usually been discouraging, especially in terms of cosmetic appearance.

METHODS

From February 2000 to March 2012, a total of 12 upper eyelids with severe cicatricial ectropion were treated with a retrograde postauricular island flap and were included in this study. Based on the pedicle of the parietal branch of the superficial temporal artery and its choke anastomoses to the posterior auricular artery, the retrograde postauricular island flap was harvested with a supra-auricular incision down to the non-hair-bearing side skin of the postauricular region. The flap was then transferred to the upper-lid lesion by passing it through a subcutaneous tunnel between the pedicle base and the upper-lid lesion. The donor site was directly closed by advancing the postauricular scalp flap into the sulcus. The largest flap was 6.5 × 3.5 cm(2).

RESULTS

After 6-12 months of follow-up, flaps survived with good color, texture, and contour. The eyelids moved freely without recurrence of ectropion. The donor site had an inconspicuous scar. No major complications occurred.

CONCLUSIONS

The retrograde postauricular island flap can be a safe, simple, and effective procedure for aesthetic correction of severe cicatricial upper-eyelid ectropion with few complications and little donor-site morbidity.

LEVEL OF EVIDENCE V

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Versatility of the posterior auricular flap in partial ear reconstruction

BACKGROUND

The posterior auricular flap alone has always been popular because of its prompt availability, its rich vascularity, and the ease of closing the donor-site defect primarily.

METHODS

Fifty-seven patients with partial ear defects covered with posterior auricular flaps during the period between 2002 and 2007 were reviewed. In the authors' series, posterior auricular flaps were harvested based on a simple random vascularization and tailored to reach almost any defect of the ear by a simplified and standardized approach.

RESULTS

The authors propose a simple nomenclature after grouping the flaps according to skin paddle type, pedicle type, pedicle base, flap transfer method, and flap movement; they present a standardized algorithm with which to choose the flap design for a given defect from this group.

CONCLUSIONS

The authors contribute three new flap designs to enhance the versatility of the posterior auricular flap. These are the superiorly and inferiorly based twisted island flaps and the posterior auricular propeller flap.

Ear defects

The projection and exposure of the auricle make it particularly susceptible to actinic injury and thus to cutaneous malignancies. Auricular reconstruction is challenging because of its unique surface anatomy and undulating topography. This article organizes auricular defects into different categories based on anatomic location and extent of tissue loss, including skin-only defects, small composite defects, full-thickness defects involving or sparing the upper third of the ear, and total auricular loss. The authors share an algorithm for repair of the array of auricular defects.

Ultralong pedicled superficial temporal fascia island flaps for lower nasal defect

OBJECTIVE

To explore the method of repairing nose defects of the apex, ala, septum, and even opposite ala nasi with ultralong pedicled superficial temporal fascia (STF) island flaps.

METHODS

There were 29 cases of defects of the apex nasi, ala nasi, and nasal columella that were reconstructed, of which 12 cases were repaired with frontal-branched STF island flaps, 14 cases with apical-branched STF postauricular island flaps, and 3 cases with prefabricated apical-branched STF postauricular island flaps. The flap areas were arranged from 1.2 x 2.3 to 2.0 x 2.8 cm2, the length more than 15 cm on average. Liners were reconstructed at the stage of the prefabricating flaps, with free skin graft in the cases of the alae nasi defects. The surfaces of the wound after flap prefabrications were covered by skin graft as well.

RESULT

Twenty-seven cases were successfully taken without blood circulation blocks; the color, texture, and figure were good, and the outcomes were satisfying. Seven nonprefabricated flap cases have epidermis necrosis due to the lack of artery perfusion pressure and venous return handicap, and the epidermis fall off after 1 month; 2 cases of which required secondary surgeries because of partial necrosis.

CONCLUSIONS

An ultralong pedicled STF island flap is an available way to repair defects of the apex nasi, ala nasi, and nasal columella. The benefits of a prefabricated flap are good blood circulation, primary made liner, and minute injury of the donor site. It is a good method of repairing defects of the apex nasi, ala nasi, nasal septum, and opposite ala nasi simultaneously.

Ultralong pedicled superficial temporal fascia island flaps for lower nasal defect

To explore the method of repairing nose defects of apex, ala, septum, and even opposite ala nasi with ultralong pedicled superficial temporal fascia (STF) island flaps. There were 29 cases with defects of apex nasi, ala nasi, and nasal columella, of which 12 cases were repaired with frontal-branched STF island flaps, 14 cases with apical-branched STF postauricular island flaps, and 3 cases with prefabricated apical-branched STF postauricular island flaps. The flap areas were arranged from 1.2 x 2.3 to 2.0 x 2.8 cm2; the length was more than 15 cm on average. Liners were reconstructed at the stage of prefabricating flaps with free skin graft in the cases of ala nasi defects. The surfaces of wound after flap prefabrications were covered by skin graft as well. Twenty-seven cases were successfully taken without blood circulation blocks; the color, texture, and figure were good, and the outcomes were satisfying. Seven nonprefabricated flap cases have epidermis necrosis because of the lack of artery perfusion pressure and venous return handicap, and the epidermis fell off after 1 month, 2 cases of which required secondary surgery because of partial necrosis. Ultralong pedicled STF island flap is an available way to repair defects of apex nasi, ala nasi, and nasal columella. Prefabricated flaps are with benefits of good blood circulation, primary-made liner, and minute injury of the donor site. It is a good method to repair defects of apex nasi, ala nasi, nasal septum, and opposite ala nasi simultaneously.

The acute surgical management of injury to the helix and antihelix in patients with large body surface area burns

Deformity or loss of the ear may be caused by superficial dermal burns or deep burns. The depth of ear burns is progressive because the ear protrudes from head and is easily affected by external pressure. Therefore, burn wounds of the ear should be debrided as early as possible, before irreversible changes of the cartilage, and covered with healthy tissue. We describe a surgical procedure for treatment of the extensively burned ear. With this technique, the helix is covered by a postauricular advancement flap, and the antihelix is covered by a skin graft. Because the procedure is straightforward and can be completed within a short time, it can be performed at the same time as other life-saving measures. The use of a skin flap permits adequate debridement in terms of both depth and width, minimising the risk of infection. The helix can be reconstructed to provide a natural appearance, and late ulcer formation due to external irritation is prevented. We have treated 15 ears on 11 patients with this procedure and have consistently obtained a satisfactory outcome.

Reverse-flow retroauricular island flap in facial reconstruction

BACKGROUND

Reconstruction of facial skin defects requires good-quality skin cover to satisfy aesthetic expectations of patient, especially when the skin defect is on the uncovered area of the face. Limitations in the available local tissue and donor-site morbidity restrict the options.

OBJECTIVE

In an effort to solve these problems, we have begun to use a subcutaneous pedicled retroauricular reverse-flow flap.

METHODS

Between January 1997 and December 2005, reverse-flow subcutaneous pedicled retroauricular island flap was used to cover facial defects in 12 patients who underwent surgical excision of skin tumor. The patients ranged in age from 44 to 81 years with a mean age of 58 years.

RESULTS

Only one case experienced a superficial necrosis in the distal one-quarter part of the flap. The functional and aesthetic results were satisfactory for both patients and surgeons, and no tumor recurrence was observed during the 12 to 28 months (mean, 18.8 months) follow-up period.

CONCLUSIONS

This flap can be used reliably for the reconstruction of facial skin defects of small and medium size. The preference of frontal branch pedicled flap enables more distal facial area defects to be covered, such as dorsal nasal, nasolabial, and upper lip, than flaps based on parietal branch.

A Comparative Study on Superior Auricular Artery Island Flaps With Various Pedicles for Repair of Periorbital Defects

Superior auricular artery (SAA) island flaps elevated from the retroauricular region have perfect color, thickness, and texture match with facial skin. In this article, reconstruction of periorbital defects with SAA island flaps is presented. Flaps were categorized into three types because they were elevated on three different pedicles. A type 1 flap was a superficial temporal vessel pedicled SAA island flap with antegrade blood flow. A type 2 flap was a reverse flow SAA island flap based on the frontal branch of the superficial temporal artery (STA). A type 3 flap was a reverse flow SAA island flap based on the parietal branch of STA. Fourteen patients (9 females and 5 males) aged between 31 years and 74 years were treated with these flaps. Two patients with lower eyelid, two patients with upper eyelid, three patients with malar, two patients with infraorbital, one patient with lateral canthal upper eyelid, and four patients with forehead defects underwent surgical intervention. Sizes of the flaps varied between 3x6 cm and 8x6 cm. Venous congestion was observed in all patients in the early postoperative period and lasted for 5 to 9 (mean, 6.6) days in type 1 flap, 5 to 9 (mean, 6.7) days in type 2 flap, and 2 to 5 (mean, 3.6) days in type 3 flap. Apart from distal necrosis of 1x1 cm in one patient and superficial dermal sloughing in two patients, no complications were encountered. Aesthetically and functionally successful results with minimal donor site morbidity were obtained in all patients during the 2 to 22 (mean 10.8) month follow-up period.

Reconstruction of the Anterior Surface of the Ear Using a Postauricular Pull-Through Neurovascular Island Flap

The auricular conchal cavity is a shallow structure in the central part of the ear. It is not only 3-dimensional, but it is a gateway to the external ear canal. Many methods have been described for reconstruction of the defect of concha-antihelix: split- or full-thickness skin grafts, regional skin, chondrocutaneous and musculocutaneous flaps, but none of the authors have described this flap with neurovascular pedicle. We used postauricular neurovascular pedicle island flap for conchal and periconchal areas of anterior surface of the external ear because it matches to the skin color, thickness and texture; scars are well hidden, and there is no donor-site morbidity. Moreover, it has a constant and reliable neurovascular pedicle. The flap edema which was present in the early postoperative period began to resolve gradually after 3 weeks and disappeared in a few months. The esthetic results were excellent in all of the patients and very satisfying for the patients, too. The sensibility was positive by light touch, pin-prick, temperature and static 2-point discrimination in the postoperative control. The static 2-point discriminations in the transferred flap and in the other ear, which corresponds to the same area, were measured. The results were nearly the same as normal values. We advocate postauricular neurovascular pedicle island flap for conchal and periconchal areas of anterior surface of the external ear because it matches the skin color, thickness and texture; scars are well hidden, and there is no donor site morbidity. Moreover, it has a constant and reliable neurovascular pedicle.

A New Approach to Retroauricular Flap Transfer

The retroauricular region provides adequate tissue of excellent color and texture match for the reconstruction of small- and medium-sized facial defects. In this study, parietal branch of the superficial temporal artery (STA) was used as the pedicle for the retroauricular island flap. Anastomoses between the parietal branch of STA, occipital artery, and contralateral STA were observed to deliver adequate nutritional blood supply to the flap. Total upper eyelid defect in 1 case, malar defect in 1 case, and forehead defects of various sizes in 4 cases were included in our study. Sizes of the flaps varied from 4 x 4.5 cm to 6 x 8 cm (mean 4.7 x 6.6 cm). All cases had venous congestion for 2-4 days (mean 3.4 days). Only 1 case experienced a superficial dermal necrosis of 1 x 3 cm in size in the distal part of the flap. Esthetic and functional results were satisfactory during the 1- to 14-month (mean 7) follow-up period. This flap is thought to be advantageous for the repair of defects and traumas of the forehead and upper eyelid as the pedicle does not develop torsion and dissection is easy.

Variability of the postauricular muscle complex: analysis of 40 hemicadaver dissections

BACKGROUND

The postauricular area is often explored by reconstructive and otologic surgeons. We previously reported on the use of postauricular tissues as a graft for wrapping hydroxyapatite implants in orbital reconstruction. This procedure reduced the incidence of implant exposure, while achieving acceptable cosmetic results. Although much is known about the postauricular area, muscle and fascial relationships and potential variations in anatomy remain ill defined.

OBJECTIVES

To identify and analyze variations in the patterns of the postauricular muscle complex (PMC) and to study the relationships of the fascial contributions from the components that make up the PMC.

METHODS

Dissections were performed using 40 fresh specimens. Muscular and fascial components of the PMC were dissected, analyzed, and photographed.

RESULTS

The PMC receives contributions from the occipitalis and trapezius muscles, the deep temporal and sternocleidomastoid fasciae, and the superior and posterior auricular and platysma muscles. Major contributors to the PMC were present in every specimen. Minor contributors were more variable in their presence and contributions. The posterior auricular muscle was identified as having several muscle bundles in 1 specimen and absent in 2 specimens (5%). The occipitalis fascia was seen to insert superior to the auricle and to blend with the deep temporal fascia in 3 cases (7%). The platysma muscle contributed to the PMC in 8 cases (20%).

CONCLUSIONS

This study demonstrated important variations in the presence and contributions of 7 previously known muscular structures and their role in forming the PMC. Seven distinct patterns are identified, and the potential clinical implications of these anatomical variations are illustrated.

Reconstruction of skin cancer defects of the auricle

PURPOSE

This article reviews the results of reconstruction of surface defects of the auricle after removal of skin cancer, and discusses the results of the delayed reconstruction method of care and modalities of treatment.

PATIENTS AND METHODS

Fifty-four patients with 62 defects involving various locations on the auricle were treated. Management included direct closure, secondary epithelization, full thickness skin grafts, local flaps using direct advancement, and rotational advancement flaps using one or more stages.

RESULTS

Nine defects were treated by direct closure with adjacent tissue, 12 defects healed by secondary epithelization, and 13 patients were treated with a full thickness skin graft. Twenty-eight defects were reconstructed with local flaps, which included the direct advancement, rotational flaps, transposition, and subcutaneous island flaps. No infections occurred.

CONCLUSION

Many options are available for reconstruction of auricular defects which yield acceptable results. Factors to consider before choosing a reconstructive format include size, location, and depth of the defect, patient medical history, smoking, and esthetic concerns. This review exposed that patients easily accept the "delayed" method of reconstruction. Delaying allows the surgeon time to research options for care and allows the patient choices of secondary epithelization and significantly reduced costs of care.

The supra-auricular arterial network: anatomical bases for the use of superior pedicle retro-auricular skin flaps

The authors present an anatomical study on vascularization of the retro-auricular skin, focusing on the origin, distribution and anastomoses of the superior auricular artery. This artery is used as the pedicle of a retro-auricular flap to repair defects in the upper third of the auricle and in the temporal region. The study was carried out on 13 fresh cadavers, with a total of 25 auricles. The common carotid artery had previously been injected with dyed latex. The superior auricular artery was found in all specimens. It had constant course and caliber, mean axial length 2.4 cm, mean caliber 0.8 mm. This artery connected the superficial temporal artery, or its parietal branch, and the posterior auricular artery network. This branch proved a reliable vascular pedicle for the mobilization of retro-auricular flaps. The results of this study are presented together with preliminary clinical results obtained using an antero-superior retro-auricular flap, never previously described, to reconstruct the superior third of the auricle and the temporal region.