Dermal vascularity of the auricle: implications for novel composite grafts

Auricular composite grafts represent a well-established technique in facial reconstruction surgery, with several advantages including high survival rate as well as less contraction and good colour match. Although the revascularisation of composite grafts reportedly occurs by inosculation and angiogenesis through both the dermal-dermal connections and the wound bed, we hypothesised that the auricular dermis might have a distinct vascular profile as compared with other regions, that might contribute to the high survival rate of auricular composite grafts. To elucidate this hypothesis, we investigated the dermal vascular profiles of several regions in fresh cadavers using a von-Willebrand factor antibody-binding technique. We assessed the vascular profiles by calculating the blood vessel density and the endothelial surface. Furthermore, we present herein some clinical cases using novel composite grafts in which graft revascularisation was likely based on the dermal-dermal connections. There was a positive correlation between the blood vessel density and the endothelial surface. We found that the postauricular dermis had a significantly richer vascularity than other skin graft donor sites such as the peri-clavicle, groin, back, buttocks and thigh, whereas the scalp and sole demonstrated an abundant vascularity as the postauricle. Unexpectedly, the cheek dermis, which is just adjacent to the auricular region, had a poor vascular profile. Because of its rapid and reliable revascularisation through dermal-dermal connections, the auricular composite graft should be more widely used in reconstructive surgery. It offers an especially good alternative in treating intractable ulcers and in tracheal reconstruction.