The Occipital Artery-Based Fascial Flap for Ear Reconstruction

Background: The temporoparietal fascia flap is frequently used in ear reconstruction. When the temporoparietal fascia flap is unavailable, options for primary or secondary salvage reconstruction are limited. In these patients, an inferiorly based occipital artery fascia transpositional flap is a good alternative for soft-Tissue coverage over a framework. This article describes the use of the occipital artery fascia flap for ear reconstruction in conjunction with a porous polyethylene framework. Methods: The authors included all patients who underwent occipital artery fascia flap surgery with a porous polyethylene framework for ear reconstruction performed by the first author from 1992 to 2017. Results: A total of 83 patients received an occipital artery fascia flap: 24 for primary microtia reconstruction and 59 for revision or salvage of unsatisfactory results. All had contraindications for temporoparietal fascia flap use: prior use, flap injury from previous surgery, trauma, inappropriate flap location, or inadequate flap perfusion. Twelve patients (14 percent) developed occipital artery fascia flap complications (infection or necrosis) and underwent further revision to achieve satisfactory results. Conclusions: Given the paucity of reported techniques for large-scale auricular salvage/revision, the authors offer a versatile option that remains available when other conventional flaps are unavailable. The occipital artery fascia flap may be used with either alloplastic or autologous frameworks. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.