Superficial temporal artery branching pattern in single stage auricular reconstruction: A novel classification

Area of Science:

• Plastic Surgery
• Microsurgery
• Anatomy

Background:

• Single-stage microtia reconstruction using porous polyethylene implants carries risks of flap necrosis and frontal nerve paralysis.
• The temporoparietal fascia (TPF) flap is crucial for this reconstruction, requiring careful management of its vascular supply, the superficial temporal artery (STA).

Purpose of the Study:

• To propose a novel classification system for STA branching patterns within TPF flaps.
• To identify anatomical risk factors associated with flap necrosis and frontal nerve damage in microtia reconstruction.

Main Methods:

• Endoscopic harvesting of 55 TPF flaps from 54 microtia patients undergoing single-stage auricular reconstruction.
• Microscopic and endoscopic evaluation of parietal and frontal branch characteristics and measurements of the STA.

Main Results:

• Frontal artery branching patterns vary, with proximity to Pitanguy's line (≤5 mm) indicating a high risk of nerve damage.
• Arterial diameters <0.5 mm for parietal (P) and frontal (F) branches are risk factors for partial flap necrosis.
• A new classification of STA branching (PF1, PF2, pF1, pF2, Pf) was proposed, with specific percentages for each type based on branch sufficiency and multiplicity.

Conclusions:

• Abnormalities in the frontal artery of the STA within TPF flaps contribute to flap necrosis and frontal nerve damage.
• A clear understanding of this new anatomical classification and precise visualization during flap harvest are essential for successful microtia reconstruction outcomes.