Nguyen Ha H, Tran Huyen T T, Vu De D, Ngo Linh M
Department of Maxillofacial-Plastic-Aesthetic Surgery, Viet-Duc University Hospital, 40 Trang Thi, Hanoi, Viet Nam; Department of Craniofacial and Plastic Aesthetic Surgery, VNU University of Medicine and Pharmacy, Hanoi, Vietnam.
Department of Maxillofacial-Plastic-Aesthetic Surgery, Viet-Duc University Hospital, 40 Trang Thi, Hanoi, Viet Nam; Department of Craniofacial and Plastic Aesthetic Surgery, VNU University of Medicine and Pharmacy, Hanoi, Vietnam.
J Stomatol Oral Maxillofac Surg. 2025 Mar;126(2):102037. doi: 10.1016/j.jormas.2024.102037. Epub 2024 Sep 5.
The two most severe complications of single-stage, porous polyethene microtia reconstruction are flap necrosis/framework exposure and frontal nerve paralysis. To reduce these risks, require a temporoparietal fascia (TPF) flap that includes both the parietal and frontal branches of the superficial temporal artery (STA) while sparing the nerve. We propose a classification that helps minimize said complications.
Fifty-five TPF flaps of 54 microtia patients who underwent single-stage auricular reconstruction from May 2018 to July 2021 were studied. Flaps were harvested using endoscopic techniques. The parietal and frontal branch characteristics and measurements were obtained using a microscope/endoscope.
The frontal artery might have 1 to 4 branches. If they were close to Pitanguy's line (≤5 mm), there would be a high risk of nerve damage. Parietal (P) and frontal (F) artery diameters <0.5 mm were risk factors for partial flap necrosis. Based on this observation, we proposed 0.5 mm as the diameter threshold to determine whether an arterial branch is hypoplasia or sufficient. From this study, a new classification of STA branching pattern was proposed with five types: PF1 (23.6 %), PF2 (43.6 %), pF1 (3.6 %), pF2 (12.8 %), and Pf (16.4 %); where P/F indicates sufficient branches, p/f indicates absent or hypoplasia ones, and the number indicates single or multiple frontal artery branching.
The risk of flap necrosis and frontal nerve damage is due to abnormalities of the frontal artery of the STA in the TPF flap. Understanding the anatomical classification with clear visualization during flap harvest ensures a successful outcome.
单阶段多孔聚乙烯耳再造最严重的两种并发症是皮瓣坏死/支架暴露和额神经麻痹。为降低这些风险，需要一块包含颞浅动脉（STA）顶支和额支且保留神经的颞顶筋膜（TPF）皮瓣。我们提出一种有助于将上述并发症降至最低的分类方法。
研究了2018年5月至2021年7月期间接受单阶段耳廓再造的54例小耳畸形患者的55块TPF皮瓣。采用内镜技术切取皮瓣。使用显微镜/内镜获取顶支和额支的特征及测量数据。
额动脉可能有1至4支。如果它们靠近皮坦古线（≤5毫米），神经损伤风险就会很高。顶动脉（P）和额动脉（F）直径<0.5毫米是部分皮瓣坏死的危险因素。基于这一观察结果，我们提出以0.5毫米作为直径阈值来判断动脉分支是发育不全还是足够。通过这项研究，提出了一种新的STA分支模式分类，共五种类型：PF1（23.6%）、PF2（43.6%）、pF1（3.6%）、pF2（12.8%）和Pf（16.4%）；其中P/F表示分支足够，p/f表示无分支或发育不全，数字表示额动脉单支或多支分支。
皮瓣坏死和额神经损伤的风险归因于TPF皮瓣中STA额动脉的异常。在切取皮瓣时清楚可视化并了解解剖分类可确保手术成功。
