Single-artery human ear graft procurement: a simplified approach.

Background. In the field of experimental facial vascularized composite tissue allotransplantation (VCA), a human auricular subunit model, pedicled on both superficial temporal (STA) and posterior auricular (PAA) arteries was described. Clinical cases of extensive auricular replantation however, suggested that a single artery could perfuse the entire flap. In our study, variants of this single pedicle approach have been studied, aiming to develop a more versatile replantation technique, in which the question of venous drainage has also been addressed. Methods. For arterial perfusion study, we harvested 11 auricular grafts, either on a single STA pedicle (n=3) or a double STA-PAA pedicle (n=8). We then proceeded to selective barium injections, in STA, PAA or both PAA-STA. Arteriograms were acquired with a Micro-CT scan and analyzed on 3D-reconstructed images. Venous drainage was investigated in eight hemi-faces, carefully dissected after latex injection. Results. Observations showed a homogenous perfusion of the whole auricle in all arterial graft variants. Venous drainage was highly variable, with either a dominant superficial temporal vein (37.5%), dominant posterior auricular vein (12.5%) or co-dominant trunks (50%). Conclusions. We demonstrated that auricular subunit VCA can be performed on a single artery, relying on the dynamic intra-auricular anastomoses between STA and PAA branches. Potentially, this vascular versatility is prone to simplify the subunit harvest and allows various strategies for pedicle selection. Venous drainage, however, remains inconstant and thus the major issue when considering auricular transplantation. (C)2017American Society of Plastic Surgeons

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