We present an interesting and novel technique to reconstruct the tragus of the ear
after oncological resection, using a pedicled chondrocutaneous superficial temporal
artery perforator (STAP) flap.
A 77-year old lady was referred to our clinic after shave biopsy of a squamous cell
carcinoma of the right tragus. We advised a wider excision and reconstruction, utilizing
like-for-like tissue of the helical root on the same ear.
Intraoperatively, wider excision of the squamous cell carcinoma was performed with
a 6-mm resection margin and the posterior branch of the superficial temporal artery
(STA) carefully preserved. Corresponding chondrocutaneous tissue of the helical root
was remarked ([Fig. 1a]
[b]).
Fig. 1 Resection defect and planned adjacent superficial temporal artery perforator (STAP)
flap: (a) Intraoperative image of resection defect and adjacent STAP flap planned for reconstruction;
(b) Schematic representation of the resection defect and blood supply to the adjacent
STAP flap.
Using the microscope and hand-held Doppler, the perforating artery of the posterior
branch of STA and its single corresponding venae-comitantes running into the helical
root tissue was identified and preserved, and the helical root tissue was incised.
Superiorly, the posterior branch STA artery and vein were ligated using microligation
clips ([Fig. 2a]
[b]).
Fig. 2 “Islanding” of superficial temporal artery perforator (STAP) flap on the posterior perforating artery of the superficial temporal artery: (a) Intraoperative photo; (b) Anatomical schematic.
The chondrocutaneous flap was transposed on the deep temporal fascia from superior
to inferior and into the tragal defect ([Fig. 3a]
[b]).
Fig. 3 Superficial temporal artery perforator (STAP) flap elevation: (a) Intraoperative photo; (b) Anatomical schematic.
The donor site was closed directly, the flap was easily inset into the oncological
resection defect, and simple interrupted sutures were used for skin closure.
Free chondrocutaneous STAP flaps have been well described[1]
[2] for nasal alar reconstruction, utilizing the posterior branch of the STA. However,
the use of a pedicled chondrocutaneous STAP flap for reconstruction of auricular defects
has not previously been described and represents an excellent reconstructive option
for defects around the ear.
Scaglioni[3] eloquently demonstrates a posterior perforator of the STA to the root of the helix
in a cadaveric study, using latex and barium sulfate injection from the external carotid
artery and the use of this angiosome to reconstruct anterior ear skin defects with
a tunneled pedicled flap. We have developed this angiosome further by using the same
perforator to elevate a chondrocutaneous flap of the root of the helix in order to
reconstruct the tragus. To the best of our knowledge, this is the first time a pedicled
chondrocutaneous flap has been described using this angiosome. Chondrocutaneous tissue
at the root of the helix offers the best aesthetic match for the tragus with very
minimal donor site deformity. The incisional scars were well placed parallel to the
relaxed skin tension lines. Further cases are needed to establish the consistency
of the blood supply, incidence of flap survival, and aesthetic result of the donor
site and recipient areas.
