Answer:
The vascular basis for this flap is the connection between the superficial temporal artery and the retroauricular artery. By including this vascular loop, the flap can be designed to carry both the postauricular and mastoid skin. The advantage of this method is the absence of a scar on the forehead. The flap length for unfurling of the pedicle is achieved by a vertical backcut in the center of the paddle. This must be performed with care so as not to interrupt the vascular loop. Washio recommends that this back cut be made from the undersurface of the flap so the vessels can be visualized directly. The donor site may be grafted or treated with a nondessicating dressing. The pedicle is divided and returned to its original position 2 to 4 weeks after transfer.