Descriptive Anatomical Variant of The Superficial Temporal Artery in Temporoparietal Fascia Flap in Microtia Reconstruction

Abstract

Introduction: Single-stage microtia auricular reconstruction is becoming more relevant. The determining factor is a temporoparietal fascia flap (TPF) with both branches of the superficial temporal artery (STA). There are not many studies regarding vascular branching and their relation with the frontal branch of the facial nerve, hence our study Materials and Methods: Anatomical study on TPF flap harvested during single-stage endoscopic assisted microtia auricular reconstruction from May 2018 to July 2021. Flaps were observed under microscope. Variables (vascular size, number of frontal/parietal branches, distance from branching location to estimated external ear canal, distance from frontal artery to projected course of facial nerve’s frontal branch etc.) and demographic information were obtained Results: Fifty-five flaps from 54 patients were included into the study. 50/55 (90,9%) had parietal branch and 55/55 (100%) had frontal branch with mean diameter of 0.98 and 0.91 mm respectively. Regarding frontal branch, 1.8%, 25.5%, 50.9%, 16.35, 5.45% had 0-4 traverse frontal branch(es), respectively. The mean distance from the frontal artery to the estimated course of the facial nerve’s frontal branch was 10.56 mm. 5/16 flaps that missing or small parietal/frontal branch (<0.5mm) had small necrosis while only 2/39 remaining flaps do, which is statically significant (p=0.018). All said necrosis were successfully repair with local flap, and no framework was removed. One case had nerve damage during flap harvest Conclusion: Detail anatomical description of the STA allow arterial-based flap designing and harvest, which in turn tremendously improve surgical success rate by diminishing flap necrosis and nerve damages.