Use of an expanded temporoparietal fascial flap technique for total auricular reconstruction

The authors propose an expanded technique of the temporoparietal facial flap of sufficient size to provide complete coverage in a single-stage procedure for the projected three-dimensional autogenous cartilage framework, including the tragus or lobule.

A temporoparietal fascial flap measuring 9 x 9 cm was prepared and wrapped around an expander. The expander was gradually infused with saline solution. Approximately 6 months after the first operation, a projected three-dimensional auricular framework was covered by the expanded temporoparietal fascial flap. Nine patients underwent total ear reconstruction using the expanded temporoparietal fascial flap technique. Of these, two cases were anotia, five were failed reconstructed microtia, and two were posttraumatic absence of ear.

A final aesthetic assessment of the results was analyzed subjectively. Three cases showed excellent results, four cases showed good results, one case showed a fair result, and one case showed a poor result.

This expansion technique is indicated in reconstruction of anotia patients who require longer and wider fascial flaps and in auricular reconstruction patients undergoing microvascular free fascial flap transfer for lessening postoperative vascular obstruction, when microvascular anastomosis is performed on the retroauricular region. The technique is also indicated in salvage auricular reconstruction for patients with an unusual vascular pattern on the temporoparietal fascial flap, or for patients showing a vascular insufficiency of the flap's distal portion after flap elevation.