The Helical Arcade

Erdmann, Detlev; Bruno, Anthony; Follmar, Keith E.; Stokes, Tracey H.; Gonyon, D.L.; Marcus, Jeffrey R.

doi:10.1097/scs.0b013e318184343a

Cited by 17 publications

(10 citation statements)

References 12 publications

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“…The convergence of the trigeminal system with C2 and C3 can also explain the underlying mechanism of the non-cervical but cranially originated nociceptive disorders on auricular flashing episodes. The highly consistent three-dimensional distribution of the ear arteries was observed for the helical rim arcade and the helical arcade shown here is in line with previous anatomical and surgical studies on the blood supply 1 , 2 , 58 .…”

Section: Discussionsupporting

confidence: 91%

Peri-arterial Autonomic Innervation of the Human Ear

Cakmak

Cotofana

Jäger

et al. 2018

Sci Rep

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Auricular vasomotor responses are considered to be signs of clinical conditions including migraine. The mechanisms of auricular vasomotor control are still debatable. This study aimed at investigating perivascular co-transmitters of vasomotor control in the auricle. Another aim was to provide three-dimensional arterial maps of the auricle, as a proxy of periarterial autonomic innervation. Twelve paired human auricles were used to visualize the arteries following Spalteholz clearing and μ-CT-based reconstruction. Perivascular innervation staining was conducted using anti-tyrosine hydroxylase (TH), anti-neuropeptide Y (NPY), anti-vasoactive intestinal peptide (VIP) and anti-choline acetyl transferase (ChAT). The combined Spalteholz technique and μ-CT revealed a highly consistent arrangement of the auricular vasculature. The superficial temporal (STA) and posterior auricular artery (PAA) supply the helical rim arcade and arcade, with the STA mainly forming the superior and the PAA forming the middle and inferior auricular artery. Co-existence of sympathetic NPY+ and TH+ terminals mediating vasoconstriction, and VIP+ and ACh+ indicating cholinergic vasodilatation, was found in the perivascular zone. The presence of both sympathetic vasoconstriction and cholinergic co-innervation for active vasodilatation was shown in the perivascular auricular zone. Assuming that the highly-consistent vasculature gives way to these terminals, this periarterial innervation may be found spread out across the helix.

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Section: Discussionsupporting

confidence: 91%

Peri-arterial Autonomic Innervation of the Human Ear

Cakmak

Cotofana

Jäger

et al. 2018

Sci Rep

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“…Two arterial networks originating mainly from the superficial temporal artery and posterior auricular artery were shown to share enormous communicating branches between them. More recently, Erdmann et al 12 at Duke demonstrated a helical arcade in cadaver studies, a vascular arcade found along the helical rim proceeding through watershed areas of communication with branches of the postauricular artery. The postauricular artery has the greatest impact on auricular blood flow, and consequently a better chance of survival is expected, provided that the postauricular arteriovenous system is preserved at the posterior aspect of the auricle.…”

Section: Discussionmentioning

confidence: 98%

Use of Hyperbaric Oxygen as Adjunct in Salvage of Near-complete Ear Amputation

Bada

Pope

2013

Plastic and Reconstructive Surgery Global Open

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Summary:There have been several cases of microvascular repair of traumatically avulsed or amputated ears in the literature. It seems that, if possible at the time of operation, microsurgical techniques yield the best results. However, because of the nature, complexity, and acuity of traumatic injuries, this option is not always feasible. Although the possibility of microsurgical repair exists, the small size of these vessels is often prohibitive, even for a skilled microsurgeon. Here, we present the case of a 4-year-old boy with almost complete amputation of the left ear attached by an inferior narrow skin pedicle after a dog bite. He was treated with primary repair and postoperative hyperbaric oxygen therapy (HBOT) with good results. This case is another example that even a narrow skin pedicle can contain artery and vein that can supply a large segment of the auricle, making primary repair feasible because of the vascular anatomy and communicating helical arcade. Also, this case demonstrates the successful use of HBOT with a pediatric patient as an adjuvant postoperative therapy.

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“…Superficial temporal artery and posterior auricular artery can be used for ear replantation [64]. The small branches form an arterial arcade to supply both the anterior and posterior surface of the ear then communicates inferiorly with the branches of the posterior auricular artery [65]. Therefore, usually only one artery anastomosis is enough for ear replantation.…”

Section: Artery and Associated Problemsmentioning

confidence: 99%

Application of Microsurgery in Facial Trauma Reconstruction

Chang¹,

Jeng²

2012

MPS

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This article is to review the role of microsurgery in facial trauma reconstruction. Microsurgery was developed since 1960s and had been applied on facial trauma from 1970s to treat amputated scalp, nose, ear and lip. Microsurgical replantation of scalp and small parts of face restores function and achieves aesthetic results, but small size of vessels and venous drainage problems are most technical challenging. In this article, we reviewed many talented authors' work to solve those problems in facial tissue replantation. If defects are huge, we need microsurgical free flaps for reconstruction. The current workhorse is anterolateral thigh flap and we reviewed the versatility and new concepts of the flap. Development of perforator flaps was another milestone of flap reconstruction because of better cosmetic result and lower donor site morbidity. We reviewed the concepts, history and application of perforator flaps. Finally, facial replantation developed in recent 5 years to treat extremely large facial defects which cannot be reconstructed with microsurgical flaps and traditional flaps alone. The task is complex and needs a large team to support the whole procedure. We also reviewed the facial allotransplantation, which is the ultimate application of microsurgery in facial trauma reconstruction.

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The Helical Arcade

Cited by 17 publications

References 12 publications

Peri-arterial Autonomic Innervation of the Human Ear

Peri-arterial Autonomic Innervation of the Human Ear

Use of Hyperbaric Oxygen as Adjunct in Salvage of Near-complete Ear Amputation

Application of Microsurgery in Facial Trauma Reconstruction

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