The Occipital Artery Based Fascial Flap for Ear Reconstruction

BACKGROUND: The temporoparietal fascia (TPF) flap is frequently used in ear reconstruction. When the TPF is unavailable, options for primary or secondary salvage reconstruction are limited. In these patients, an inferiorly based occipital artery fascia (OCF) transpositional flap is a good alternative for soft tissue coverage over a framework. This paper describes the use of the OCF flap for ear reconstruction in conjunction with a porous polyethylene (PPE) framework. METHODS: We included all patients who received an OCF flap with PPE framework for ear reconstruction from the first author from 1992-2017. RESULTS: A total of 83 patients received an OCF flap: 24 for primary microtia reconstruction and 59 for revision or salvage of unsatisfactory results. All had contraindications for TPF flap utilization: prior use, flap injury from previous surgery, trauma, inappropriate flap location, or inadequate flap perfusion. Twelve patients (14%) developed OCF flap complications (infection or necrosis) and underwent further revision to achieve satisfactory results. CONCLUSIONS: Given the paucity of reported techniques for large-scale auricular salvage/revision, we offer a versatile option that remains available when other conventional flaps are unavailable. The OCF flap may be used with either alloplastic or autologous frameworks. Authors' Contributions: John Reinisch: Operating surgeon, concept, data collection, manuscript drafting Claire (Vera Aimée) van Hövell tot Westerflier: manuscript drafting Youssef Tahiri: manuscript revision Caroline A. Yao: Concept, data collection, manuscript drafting Financial Disclosure and Products Page: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Corresponding Authors: Reinisch, John M.D., Cedars Sinai Medical Center, 250 N. Robertson Blvd., Suite 506, Beverly Hills, CA 90211, Phone: (310) 385-6090, Fax: (310) 385-6092, E-mail: jfr654@aol.com Caroline A. Yao M.D., M.S., Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, E-mail: caroline.yao.md@gmail.com ©2018American Society of Plastic Surgeons

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