Revisiting the temporal artery posterior auricular skin flap with an anatomical basis stepwise pedicle dissection for use in targeted facial subunit reconstruction

Abstract

Background: This study demonstrates the anatomy of the pedicled temporal artery posterior auricular skin (TAPAS) flap, its variable arc of rotation based on stepwise dissection, and case reports demonstrating clinical use. This flap provides excellent color match and ultrathin tissue for targeted reconstruction of small-to medium-sized facial subunit defects. Methods: Twenty-six cadaver dissections were performed. The authors measured the reach and rotation limits of the flap in a pedicled fashion depending on a stepwise approach for vascular pedicle dissection. Two clinical cases demonstrating maximum arc of rotation are seen. Results: The pedicled TAPAS flap maximal rotation limits allow for reconstruction of facial subunits encompassing nearly the entire ipsilateral face. No venous congestion, wound complications, or partial/total flap loss were encountered with extreme clinical applications. Conclusion: The pedicled TAPAS flap has extensive versatility for reconstruction of a variety of facial subunit defects. The flap also has, in theory, multiple applications for intraoral reconstruction. K E Y W O R D S facial flap, facial reconstruction, head and neck, pedicle flap, TAPAS flap 1 | BACKGROUND The repair of small-to medium-sized defects of the head and neck can represent a challenging problem for surgeons when local soft tissue flaps do not provide adequate tissue volume or appropriate tissue quality to meet the desired reconstructive needs. In these instances, regional pedicled flaps or free tissue transfers become the reconstructive modalities of choice; however, reliance on distant donor sites can lead to mismatches in tissue color, texture, or bulk, which can lead to suboptimal function and contour of the reconstruction site. 1-3 In light of these considerations, multiple revision procedures are often required to further refine the reconstruction. 2

Application of Modified Triangular Perforator Flap in Repair of Small and Medium-Sized Facial Defect

“…In contrast with skin grafting, remote skin flap and free skin flap have a simple operation with satisfactory postoperative results. 1 Local pedicled flaps have been designed and applied in numerous scenarios, 2 including V-Y flaps, Z-shaped flaps, Limberg flaps, and multilobed flaps. Perforator flaps have been extensively applied in clinical practice.…”

Reconstruction of Large Periorbital Defect With a Pre-expanded Retrograde Postauricular Island Flap: Our 13-Year Experiences

“…The posterior auricular skin was considered as an ideal substitute for the periorbital skin in thickness, color, and texture 2 . Based on the superficial temporal artery (STA) and its anastomosis with posterior auricular artery (PAA), the postauricular skin started to be used in periorbital reconstruction since 1960s in the form of a retrograde island flap 3,4 . However, soon the flap was found at a high risk of venous complications, eventually leading to the flap necrosis 1,2,5,6 .…”