Nguyen Ha H, Vu De D, Ngo Linh M, Tran Huyen T T
Department of Maxillofacial, Plastic and Aesthetic Surgery, Viet-Duc University Hospital, 40 Trang Thi street, Hoan Kiem district, Hanoi, Vietnam; Department of Craniofacial and Plastic Aesthetic Surgery, University of Medicine and Pharmacy, Vietnam National University, 144 Xuan Thuy street, Cau Giay district, Hanoi, Vietnam.
Department of Craniofacial and Plastic Aesthetic Surgery, University of Medicine and Pharmacy, Vietnam National University, 144 Xuan Thuy street, Cau Giay district, Hanoi, Vietnam.
J Plast Reconstr Aesthet Surg. 2024 Apr;91:105-110. doi: 10.1016/j.bjps.2024.01.029. Epub 2024 Feb 1.
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 in people with microtia.
We conducted an anatomical study on the TPF flap harvested during single-stage endoscopic-assisted microtia auricular reconstruction from May 2018 to July 2021. We observed the flaps under endoscopic and surgical microscopes to determine several variables (vascular size, number of frontal/parietal branches, distance from the branching location to the estimated external ear canal, distance from the frontal artery to projected course of facial nerve's frontal branch, etc.).
The study included 55 flaps from 54 patients. Of the 55 flaps, 50 (90.9%) had a parietal branch, and all 55 (100%) had a frontal branch with a mean diameter of 0.98 and 0.91 mm, respectively. Regarding the frontal artery, 1.8%, 25.5%, 50.9%, 16.35% and 5.45% had 0-4 traverse frontal branch(es), respectively. The mean distance from the frontal artery to the estimated course of the frontal nerve was 10.56 mm. Parietal artery absence is more likely in patients with severe hemifacial microsomia or STA trunk go under the auricular cartilage remnants (p < 0.05). Either frontal or parietal artery absence or small diameter can cause necrosis. Frontal arteries travelling near the frontal nerve may result in post-operative nerve palsy.
Microtia auricular reconstructive surgery is always a big challenge for plastic surgeons. Anatomical variants are common. A detailed anatomical description of the STA, with the help of microsurgery and endoscopy, allows arterial-based flap designing and harvest, which tremendously improves surgical success rate by diminishing flap necrosis and nerve damage.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
单阶段小耳畸形耳廓再造术正变得越来越重要。决定因素是带有颞浅动脉（STA）两个分支的颞顶筋膜瓣（TPF）。关于小耳畸形患者血管分支的研究并不多。
我们对2018年5月至2021年7月单阶段内镜辅助小耳畸形耳廓再造术中获取的TPF瓣进行了一项解剖学研究。我们在内镜和手术显微镜下观察这些瓣，以确定几个变量（血管大小、额/顶分支数量、分支位置到估计外耳道的距离、额动脉到面神经额支预计走行的距离等）。
该研究纳入了54例患者的55个瓣。在这55个瓣中，50个（90.9%）有顶支，所有55个（100%）有额支，平均直径分别为0.98和0.91毫米。关于额动脉，分别有1.8%、25.5%、50.9%、16.35%和5.45%有0至4条横行额支。额动脉到额神经预计走行的平均距离为10.56毫米。严重半侧颜面短小畸形患者或STA主干走行于耳廓软骨残余下方的患者更可能无顶动脉（p<0.05）。额动脉或顶动脉缺失或直径小都可能导致坏死。走行于额神经附近的额动脉可能导致术后神经麻痹。
小耳畸形耳廓再造手术对整形外科医生来说始终是一项巨大挑战。解剖变异很常见。借助显微手术和内镜对STA进行详细的解剖描述，有助于基于动脉的瓣设计和获取，通过减少瓣坏死和神经损伤极大地提高手术成功率。
临床问题/证据级别：治疗性，IV级。
