The anatomy and application of the postauricular fascia flap in auricular reconstruction for congenital microtia.

Abstract

The various layers of the scalp are widely used in reconstructive procedures. The technique used for soft tissue coverage seems to influence the framework extrusion rate in auricular reconstruction. We have investigated the role of the postauricular fascial flap in providing ample, thin neurovascular cover to facilitate ear reconstruction in congenital microtia. Following postauricular cutaneous tissue expansion, the postauricular neurovascular fascia flap was raised to partially cover the projected three-dimensional autogenous cartilage framework. A suction drain was placed in the pocket to allow the skin to coapt to the framework and a split-thickness skin graft was applied to complete coverage. At final assessment, the aesthetic results were analysed subjectively. Four hundred and thirty-eight ears underwent total ear reconstruction in 428 patients using the postauricular fascial flap technique. None of the reconstructions failed, and all patients were satisfied with the results. The use of a postauricular fascial flap and skin graft enhances safety and provides better vascularisation of the underlying cartilage.