Anatomical and technical aspects of harvesting the auricle as a neurovascular facial subunit transplant in humans

BACKGROUND: Auricular transplants from cadaveric sources may be a viable alternative for difficult auricular reconstruction once immunologic problems are largely solved. The authors report on the neurovascular anatomy and technical details of harvesting the auricle as a single facial subunit. METHODS: Nine auricles were studied in latex-injected (n = 5) and fresh cadaveric heads (n = 4). In latex-injected heads, dissection in the neck and auricular region and microdissection within the substance of the auricle were performed under loupe magnification. The arterial network was exposed and measurements were taken, including the size, length, and diameters of vessels. The number of branches supplying the entire auricle was noted. Methylene blue dye was injected into fresh cadaveric heads through the posterior auricular (n = 2) or superficial temporal arteries (n = 2) to assess the territory supplied by each arterial system. RESULTS: Dye injected into the superficial temporal artery stained the upper two-thirds of the anterior and posterior auricular regions; all anterior cartilaginous eminences, except the antitragus, were homogenously stained. Dye injected into the posterior auricular artery stained the lobule, posterior auricular skin, and the depressed anterior auricular regions, including the cavum conchae, scapha, and triangular fossa. Neither the superficial temporal nor the posterior auricular arteries could adequately nourish the entire auricle as single pedicles. The auriculotemporal and great auricular nerves can be included in the transplant for sensation. The temporoparietal scalp can also be reliably included to meet reconstructive requirements. CONCLUSIONS: The auricle can be reliably elevated as a transplant when nourished by both the superficial temporal and posterior auricular arterial systems. The external jugular vein and external carotid artery can therefore be used as the vascular pedicle for auricular transplantation.