J Reconstr Microsurg 2006; 22 - A004
DOI: 10.1055/s-2006-955124

Anatomical and Technical Aspects of Harvesting Auricle as One Neurovascular Facial Subunit Transplant in Humans

Jang-Yee Lin 1, Betul Gozel Ulusal 1, Ali Engin Ulusal 1, Bien Keem Tan 1, Chin-Ho Wong 1, Mohamed Z Rasheed 1, Colin Song 1, F.C. Wei 1
  • 1Singapore General Hospital and Chang Gung Memorial Hospital, Taipei, Taiwan

Aurical transplants from cadaveric sources can be a viable alternative for difficult auricle reconstruction once immunologic problems are largely solved. In this study, the authors explored the vascular anatomy and technical details of harvesting the auricle as one neurovascular facial subunit.

A total of nine auricles was studied in latex-injected (n = 5) and fresh (n = 4) cadaver heads. In the latex-injected heads, dissection in the neck and auricular region and microdissection within the substance of the auricle was carried out using loupe magnification. The arterial network including the size and the number of the branches supplying the entire auricle was exposed. Vessel length and diameters were assessed using a vernier caliper. Selective methylene blue dye injection studies were performed in the fresh cadaver heads using the posterior auricular artery (n = 2) and superficial temporal artery (n = 2) and the territory from each arterial system was assessed.

Neither the superficial temporal artery (STA) nor the posterior auricular arteries (PAA) alone were adequate to nourish the entire auricle. Injection of the STA stained the lower two thirds of the upper posterior and anterior auricle regions. The lobule of the auricle and prominent parts of the auricle were predominantly stained by injection throough the posterior auricular artery. Further, they found that it is feasible to include the auriculotemporal and great auricular nerves to the transplant in order to attain sensory recovery. The inclusion of temporal and/or parietal scalp can also be feasible, depending on the recipient-site requirements.

Reliable and consistent blood supply of the auricle as a transplant can be provided by inclusion of both the superficial temporal and posterior auricular arterial systems. Therefore, the external jugular vein and external carotid artery can be used as the vascular pedicle if the auricle is to be transplanted.