Endoscopic-Assisted Harvest of Temporoparietal Fascia Flap Through a Single Incision for Single-Stage Auricular Reconstruction With Porous Polyethylene Framework

Single-stage auricular reconstruction using a porous polyethylene (PPE) framework with temporoparietal fascia flap (TPFF) coverage has become increasingly popular for microtia correction. This technique reduces the number of operative stages and avoids donor-site morbidity from rib cartilage harvest. We describe our refined approach combining PPE framework implantation with endoscopic-assisted TPFF harvest via a single small incision. Preoperative planning includes 256-slice contrast-enhanced MSCT angiography and Doppler mapping to delineate the branching pattern of the superficial temporal artery (STA), guiding flap design while minimizing risk of damaging the frontal branch of the facial nerve. Intraoperative endoscopic magnification ensures clear visualization of STA branches and interconnections, preserving all small anastomoses to improve flap viability. We also propose an anatomic classification of STA branching patterns. On the basis of our experience with 113 patients, this approach improves surgical precision, reduces complications, enhances team teaching, and achieves excellent aesthetic outcomes.