The vascular anatomy and angiosome of the posterior auricular artery. A cadaver study.

BACKGROUND Pedicled flaps based on the posterior auricular artery have been used for small auricular and mastoid cavity defects. OBJECTIVE To precisely define the vascular anatomy and angiosome (cutaneous distribution) of the posterior auricular artery. METHODS A fresh cadaver model was used for 3 separate investigations, studying the posterior auricular artery. Intra-arterial ink injections defined the angiosome, and subtraction angiography and latex injection defined the vascular anatomy in relation to bony and soft tissue landmarks. SUBJECTS Eight fresh cadavers, 6 men and 2 women, were used, varying in age from 58 to 85 years. RESULTS The posterior auricular artery has a predictable course in the posterior auricular sulcus. The branching pattern over the auricle and temporal bone and the artery's relationship to bony and soft tissue landmarks were consistent. The angiosome includes the anterior and posterior surfaces of the auricle and the periauricular skin superiorly, posteriorly, and inferiorly. CONCLUSIONS The investigation documented the consistent vascular anatomy and angiosome of the posterior auricular artery. The cutaneous distribution suggests that a large pedicled or island flap based on the posterior auricular artery may be raised safely as a myocutaneous or myofasciocutaneous flap with temporalis fascia and/or periosteum, extending previously published dimensions. Further studies may extend the clinical application to include free flaps based on the posterior auricular artery.