Temporoparietal fascia flap "sandwich" technique for repair of near-total traumatic auricle avulsion.

INTRODUCTION The most common mechanisms of traumatic ear injury are bites, motor vehicle accidents, and assault with knives or firearms. Repair of traumatic auricle avulsion is technically and aesthetically challenging, primarily because of the irregular and unique cartilaginous anatomy of the ear. Classic replantation of a nonvascularized composite graft may succeed if the amputated portion of the auricle is <15 mm. However, an inadequate blood supply often makes classic replantation of cartilage without microvascular anastomosis an unfavorable option, with failure rates exceeding 60%. To minimize the risk of necrosis and improve success rates, microsurgical anastomosis is the preferred first step in management, though the use of synthetic implants, pocketing techniques, or flap coverage of the avulsed cartilage are acceptable alternatives when direct reanastomosis is impossible. The temporoparietal fascia (TPF) has been used as a free and pedicled flap in head and neck reconstruction as well as repair of upper and lower extremity deformities. It is a lateral extension of the galea aponeurotica and continuous with the superficial musculoaponeurotic system inferiorly. Its thin, pliable nature, consistent vascular anatomy, and ability to readily accept skin grafts on both surfaces make it ideal for reconstructive surgery requiring delicate tissue coverage. Here we demonstrate a sandwich technique in which a pedicled TPF flap with full-thickness skin graft from the avulsed auricle itself is particularly well suited for the reconstruction of a subtotal traumatic ear avulsion where microvascular anastomosis is not possible.