Microvascular reconstruction of nasal ala using a reversed superficial temporal artery auricular flap

Microsurgical technique allows successful transfer of an auricular flap in a one-stage procedure, using the root of the helix. Although a free composite auricular flap with the superficial temporal artery pedicle provides a good solution to repair nasal defects, its vascular pedicle is so limited that a vein graft from other area of the body is usually needed to reach the recipient site, leaving an unpleasant scar on the donor site. The authors present a reversed superficial temporal artery auricular free flap for alar reconstruction by microsurgical transfer. This technique has been performed on four patients with posttraumatic alar defects. In three patients, the reversed superficial temporal vessels of the flap were anastomosed directly with the recipient facial vessels in the nasolabial fold. In one patient, the reversed superficial temporal artery of the flap was anastomosed with the facial artery as above, its accompanying vein to the proximal stem of the superficial temporal vein by a graft taken from the excess length of the reversed superficial temporal artery pedicle because a suitable vein was not found for microvascular anastomosis in the nasolabial area. In these four patients, the size of the flap was 2.5 × 2.0–4.0 × 2.5 cm, the length of the vascular pedicle is 5–8 cm, average 6.5 cm. The reversed superficial temporal artery auricular flap offers a long vascular pedicle of the auricular free flap for microvascular anastomosis in the reconstruction of the ala of nose, delivers a good solution to the problem of the vascular pedicle shortage of the proximal superficial artery auricular flap. There is no need of vein graft from other parts of the body because the superficial temporal vessels on the temple provide not only the flap pedicle but also a source of vessel grafts. This technique may have even wider applications in other facial cutaneous defect.