The combined posterior temporoparietal and galeal fascial flap: a new flap in the elevation of the constructed auricle (second stage of microtia correction)

Over the past few years, the technique of elevating the buried ear framework in the second stage of microtia correction has shifted from skin grafting to the use of flaps and cartilage blocks in the retroauricular sulcus. While the temporoparietal fascial flap should be reserved for secondary procedures and the treatment of complications, the mastoid fascial flap is inadequate by itself and needs an additional cartilage graft. Here, we describe a new flap, the combined posterior temporoparietal and galeal fascial flap, for the elevation of the buried ear cartilage. The flap is robust, with a dependable blood supply based on the posterior branches of the superficial temporal artery. In four cases the flap was rolled up and inset into the retroauricular sulcus, while in three cases an additional conchal cartilage graft was inserted into the roll. All the patients had satisfactory ear projection at follow-up 10-14 months postoperatively. We discuss the surgical technique and the advantages of this flap. We believe that this new flap, which has not been described before, has the potential to replace other flaps in the second stage of microtia correction. (C) 2002 The British Association of Plastic Surgeons.