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International Journal of Oral and... May 2022Full-thickness defects of the distal nose are an ongoing surgical challenge. Among the available techniques, pre-auricular chondrocutaneous free flaps based on the...
Full-thickness defects of the distal nose are an ongoing surgical challenge. Among the available techniques, pre-auricular chondrocutaneous free flaps based on the superficial temporal artery (STA) have good aesthetic and functional outcomes. However they often require autologous venous grafts. The aim of this radio-anatomical study was to evaluate the feasibility of the helix root free flap based on the posterior auricular artery (PAA). Vascular lengths, diameters, and networks were investigated in flaps harvested from cadavers. The perfusion of the flaps was studied by injecting patent blue. Some flaps were also injected with contrast agent and studied by angiography and computed tomography. Ten flaps from seven fresh cadavers were dissected and analysed. The mean length of the PAA was 114.2 mm and the mean diameter was 2.2 mm. Perfusion was investigated in six flaps and considered good in three of these. The study results demonstrate the feasibility of PAA-based helix root free flaps. This alternative technique provides an 11 cm pedicle with vessels of appropriate calibre, facilitating any potential microsurgery. The scar is mostly hidden behind the ear. This PAA-based helix root free flap could be a reliable and promising single-stage procedure to repair complex defects of the alae nasi.
Topics: Arteries; Cadaver; Esthetics, Dental; Free Tissue Flaps; Humans; Nose; Plastic Surgery Procedures
PubMed: 34716072
DOI: 10.1016/j.ijom.2021.10.004 -
Posterior auricular artery free flap reconstruction of the retroauricular sulcus in microtia repair.Journal of Plastic, Reconstructive &... Sep 2021Autologous repair using costal cartilage grafts remains the most widely accepted method of microtia reconstruction. A major complication of current techniques is loss of...
BACKGROUND
Autologous repair using costal cartilage grafts remains the most widely accepted method of microtia reconstruction. A major complication of current techniques is loss of ear shape caused by scarring, contracture and cartilage absorption. We present a new surgical technique utilizing the posterior auricular artery free flap in microsurgical reconstruction of the retroauricular sulcus in microtia.
METHOD
Reconstruction is performed in two stages. In the first stage, a fabricated costal cartilage framework is inserted into a skin pocket as described by Nagata. In the second stage, the ear framework is elevated from the scalp and held by an additional cartilage wedge. Following indocyanine green angiography perforator mapping, a posterior auricular artery perforator flap is harvested from the contralateral (normal) ear and used to reconstruct the posterior auricular sulcus covering the cartilage framework and elevating wedge.
RESULTS
The technique was applied to three patients aged 11-15 years with a follow-up time of 8 months to 3 years. The average flap artery diameter was 0.73 mm and the vein was 0.7 mm. Venous congestion occurred in one case and was resolved with a vein graft leading to complete flap recovery. Good ear shape, elevation, projection, skin color and texture were achieved in all the cases.
CONCLUSION
Posterior auricular artery flap reconstruction of the retroauricular sulcus in microtia repair is a useful alternative to the current skin graft and tissue expander-based techniques. It provides the ideal skin color and texture match and may improve the overall results of microtia reconstruction by enhancing vascularity.
Topics: Adolescent; Angiography; Arteries; Child; Congenital Microtia; Costal Cartilage; Ear; Female; Free Tissue Flaps; Humans; Indocyanine Green; Male; Plastic Surgery Procedures
PubMed: 33518502
DOI: 10.1016/j.bjps.2020.12.047 -
Laryngoscope Investigative... Oct 2022In our previous cadaveric study, we highlighted the posterior auricular artery (PAA) as a potential landmark for early identification of facial nerve (FN) when...
BACKGROUND
In our previous cadaveric study, we highlighted the posterior auricular artery (PAA) as a potential landmark for early identification of facial nerve (FN) when performing parotidectomy. However, further clinical study is critically needed before this landmark could be applied in clinical practice.
METHODS
For 31 patients enrolled, we tried to identify the FN by the guide of the PAA during parotidectomy. Additionally, the FN function was evaluated during follow-up.
RESULTS
PAA could be exposed in 28 out of 31 (90.3%) patients during parotidectomy. Moreover, the FN trunk could be identified by the guide of the PAA in all these 28 patients with identifiable PAA. Furthermore, no iatrogenic FN damage happened in this study and the transient FN dysfunction rate was 5.7%.
CONCLUSION
The PAA is an ideal landmark for early identification of the FN trunk when performing parotidectomy.
PubMed: 36258872
DOI: 10.1002/lio2.894 -
World Neurosurgery Dec 2017Direct extracranial-intracranial (EC-IC) bypass is one of the fundamental techniques to prevent recurrent stroke in patients with adult-onset ischemic moyamoya disease.... (Review)
Review
BACKGROUND
Direct extracranial-intracranial (EC-IC) bypass is one of the fundamental techniques to prevent recurrent stroke in patients with adult-onset ischemic moyamoya disease. When the standard superficial temporal artery (STA) cannot be used for a graft, the posterior auricular artery (PAA) can be a potential surrogate graft.
CASE DESCRIPTION
In this article, the authors reported a 34-year-old female patient suffering from ischemic moyamoya disease. To widely revascularize the anterior half of the hemisphere, direct double EC-IC bypass was considered beneficial; however, she had only a single-branched STA but had a prominent branch of the PAA. After discussion, a direct double surgical revascularization was successfully performed using a combination of the STA-middle cerebral artery (MCA) and the PAA-MCA bypass. The authors herein reported the detailed surgical technique of the PAA-MCA bypass with an informative video of the actual procedure. To clearly define the feasibility of PAA-MCA bypass, the authors also conducted a literature review, yielding 3 previous articles describing the bypass.
CONCLUSION
In conclusion, the PAA becomes a potential donor for EC-IC bypass as long as its diameter is approximately 1.0 mm. Even though the PAA-MCA bypass is not primarily considered in the initial revascularization, it can be useful as a combination bypass with other grafts or as a rescue for recurrent ischemia.
Topics: Adult; Cerebral Angiography; Cerebral Revascularization; Computed Tomography Angiography; Female; Humans; Imaging, Three-Dimensional; Middle Cerebral Artery; Moyamoya Disease; Tomography, Emission-Computed, Single-Photon; Treatment Outcome
PubMed: 28939540
DOI: 10.1016/j.wneu.2017.09.005 -
International Journal of Oral and... May 2022The surgical repair of full-thickness defects involving the alae nasi is complex. Pedicle flaps such as frontal and nasolabial flaps can be used, but require several...
The surgical repair of full-thickness defects involving the alae nasi is complex. Pedicle flaps such as frontal and nasolabial flaps can be used, but require several interventions with different techniques. In contrast, free flaps from the foot of the ear helix allow the three layers of the nasal wings to be reconstructed in a single operation. Nevertheless, in the classical approach, the vascular pedicle is short. Although some authors have proposed raising the flap in a retrograde manner, this still yields a relatively short pedicle with narrow vessels. In the companion paper, we demonstrated that a posterior auricular artery helix root free flap (PAAHF) can be harvested from the posterior auricular vessels, thus increasing the useful pedicle length. The case of a patient with basal cell carcinoma of the left ala is presented here. A right helix root free flap was anastomosed with the facial vessels at the left mandibular notch. This new flap overcomes the main limitation of the classical helix root flap, namely the length of the pedicle. It has all of the morphological qualities of the classical flap, but with simpler vascular assembly, since autologous venous grafts and complex anastomoses are not required.
Topics: Arteries; Free Tissue Flaps; Humans; Nose; Nose Deformities, Acquired; Plastic Surgery Procedures; Skin Neoplasms
PubMed: 34716073
DOI: 10.1016/j.ijom.2021.10.005 -
Acta Neurochirurgica Nov 2014Sometimes the superficial temporal artery (STA) is not available for an extracranial-intracranial (EC-IC) bypass procedure. An alternative vessel for an EC-IC bypass is... (Review)
Review
BACKGROUND
Sometimes the superficial temporal artery (STA) is not available for an extracranial-intracranial (EC-IC) bypass procedure. An alternative vessel for an EC-IC bypass is the posterior auricular artery (PAA) if it extends to the temporoparietal area with a diameter large enough. We assessed the prevalence of an appropriate PAA as an alternative donor vessel and report three illustrative cases in which the PAA was used for EC-IC bypass surgery.
METHODS
A literature search was performed on the use of the PAA as a donor vessel for bypass surgery. Secondly, a prospective database of bypass surgeries was reviewed to calculate the prevalence of a PAA with a diameter of at least 1 mm in the parietotemporal area. Finally, three illustrative cases are reported that describe various indications for the revascularisation procedures with their clinical, surgical and imaging features.
RESULTS
Two articles have previously described the use of the PAA for bypass surgery and their results are summarised. The prevalence of a PAA that would be appropriate for an EC-IC bypass in patients with intracranial vascular pathology is 5.7%. The presented cases demonstrate that the PAA can be successfully used for EC-IC bypass surgery with good flow velocities and patency.
CONCLUSIONS
The PAA is a rarely described as an appropriate donor vessel for an EC-IC bypass. Its prevalence is 5.7% and it can successfully be used as an alternative donor vessel. The awareness among cerebrovascular surgeons about the presence of a PAA and knowledge about its anatomy may be valuable.
Topics: Adult; Carotid Artery, External; Carotid Artery, Internal; Cerebral Revascularization; Databases, Factual; Ear Auricle; Female; Humans; Infarction, Middle Cerebral Artery; Male; Moyamoya Disease; Neurosurgical Procedures; Prospective Studies; Treatment Outcome
PubMed: 25160851
DOI: 10.1007/s00701-014-2206-6 -
Annals of Plastic Surgery Sep 2021Various local techniques have been successfully used for the reconstruction of auricular defects. However, most local techniques are not suitable for extensive auricular...
BACKGROUND
Various local techniques have been successfully used for the reconstruction of auricular defects. However, most local techniques are not suitable for extensive auricular defects. The aim of this study is to investigate the utility of a retroauricular artery perforator-based propeller flap for the reconstruction of extensive auricular defects by evaluating aesthetic outcomes using objective and quantitative parameters.
METHODS
Twenty-one patients with extensive full-thickness and partial-thickness defects were treated with retroauricular artery perforator-based propeller flaps harvested from the mastoid and neck regions. The surgical procedures were performed using single-stage reconstruction in postauricular partial-thickness defects and 2-stage reconstruction in full-thickness auricular defects. Levels of final satisfaction and tissue matching as well as donor scar perception were evaluated by the patients and objective observers.
RESULTS
The original sizes and projections of the auricles were achieved. The color, texture, and thickness of the flaps matched well with the adjacent auricles. The vast majority of the patients and observers were very satisfied with the surgical outcome.
CONCLUSIONS
Retroauricular artery perforator-based propeller flaps may preserve the size and projection in both partial- and full-thickness extensive defects of the auricle. With this procedure, there was also excellent matching of the color, texture, and thickness of the flap with the adjacent tissue, as well as acceptable levels of donor scarring, thereby achieving satisfactory aesthetic outcomes.
Topics: Arteries; Ear Auricle; Ear, External; Humans; Perforator Flap; Plastic Surgery Procedures; Treatment Outcome
PubMed: 33625022
DOI: 10.1097/SAP.0000000000002753 -
AJNR. American Journal of Neuroradiology Jun 2021In certain cases of pediatric patients with Moyamoya disease undergoing encephaloduroarteriosynangiosis (EDAS) treatment, the posterior auricular artery can be used as...
BACKGROUND AND PURPOSE
In certain cases of pediatric patients with Moyamoya disease undergoing encephaloduroarteriosynangiosis (EDAS) treatment, the posterior auricular artery can be used as an alternative when the parietal branch of the superficial temporal artery is unavailable. In this study, anatomic variations of the superficial temporal and posterior auricular arteries in pediatric patients with Moyamoya disease and postoperative outcomes of posterior auricular artery-EDAS are explored.
MATERIALS AND METHODS
Medical records of 572 patients with Moyamoya disease who underwent surgical procedures from 2007 to 2017 at the Seoul National University Children's Hospital were reviewed. Anatomic classifications of the superficial temporal and posterior auricular arteries were based on previous classifications. Postoperative hemodynamic changes of posterior auricular artery-EDAS were analyzed using the Matsushima grade. Also, Karnofsky Performance Scale and mRS scores of posterior auricular artery-EDAS cases were reviewed to identify postoperative clinical outcomes.
RESULTS
Among 1144 hemispheres, 24 were considered posterior auricular artery-EDAS candidates (2.1%). Of those, 10 hemispheres underwent posterior auricular artery-EDAS (41.7%, in total hemispheres 0.9%). Comparing the Matsushima grades of the superficial temporal artery-EDAS and posterior auricular artery-EDAS groups showed similar postoperative revascularization. Postoperative Karnofsky Performance Scale and mRS scores of patients having undergone posterior auricular artery-EDAS did not show deterioration.
CONCLUSIONS
In approximately 2% of pediatric patients with Moyamoya disease for whom the superficial temporal artery is unavailable as the EDAS donor, the posterior auricular artery can be considered an alternative. On the basis of the results, the clinical outcome of posterior auricular artery-EDAS was not inferior to that of superficial temporal artery-EDAS. Hence, we suggest an in-depth consideration of the posterior auricular artery as the donor artery if the superficial temporal artery parietal branch is unavailable.
Topics: Adolescent; Anatomic Variation; Cerebral Angiography; Cerebral Revascularization; Child; Child, Preschool; Female; Humans; Male; Moyamoya Disease; Retrospective Studies; Temporal Arteries; Treatment Outcome
PubMed: 33737264
DOI: 10.3174/ajnr.A7059 -
Anatomical Science International Sep 2023Anatomical variations between the facial nerve and adjacent arteries are rare. However, knowledge of such anatomical variations is important to the surgeon who operates... (Review)
Review
Anatomical variations between the facial nerve and adjacent arteries are rare. However, knowledge of such anatomical variations is important to the surgeon who operates on or near the facial nerve. Herein, we report an unusual finding between the extracranial part of the facial nerve and a nearby artery. During routine dissection of the right facial nerve trunk, the posterior auricular artery was found to pierce the nerve effectively forming a nerve loop. The nerve was pierced by the artery soon after its exit from the stylomastoid foramen. This case is detailed and a review on this topic presented, specifically identifying previously reported studies describing this or similar variations, and the relationship between the posterior auricular artery and facial nerve trunk in general. Piercing of the facial nerve trunk by the posterior auricular artery appears to be rare. However, such a relationship should be known by the clinician who treats patients with pathologies of the facial nerve trunk. To our knowledge, this is the first report of this variation in an adult. Due to such rarity, this case is of archival value for those who might describe it or similar cases in the future.
Topics: Humans; Adult; Facial Nerve; Head; Temporal Bone; Dissection; Arteries; Cadaver
PubMed: 36879134
DOI: 10.1007/s12565-023-00708-8