THE VASCULAR BASIS OF GAVELLO’S FLAP
The posterior auricular artery arises in the neck from the external carotid artery, and ascends between the auricle and mastoid process. It supplies the cranial surface of the auricle via its auricular branch, and the occipital belly of occipitofrontalis and the scalp behind and above the auricle via its occipital branch. Our observation of digital subtraction angiography (DSA) images of different individuals undergoing DSA for unrelated causes revealed that the occipital branch of the posterior auricular artery that runs horizontally behind the ear is a constant vessel in the area where Gavello’s flap is raised (Figure 1).
Figure 1) Digital subtraction angiography image demonstrating the occipital branch of posterior auricular artery
Description of the procedure: Figures 2a and 2B
A straight line (A-B) is drawn on the postauricular mastoid skin, along the cut margin of the earlobe. This line is further extended posteriorly to a point C, so that AB = BC. A point D is marked approximately 1 cm vertically below the point A. From point D, a double-curved line (D-E-C) is drawn, joining points D and C. The bilobed flap thus formed is raised by subcutaneous dissection with caution to avoid injury to the posterior auricular artery, which runs at the base (A-D) of the flap. The cut margin of the earlobe is paired and freshened. The bilobed flap is folded on itself along B-E. AB and BC are sutured with the anterior and posterior paired margins of theearlobe, respectively. The lower curved borders of the bilobed flap are sutured with one another to form the free margin of the new earlobe. The donor site defect is closed primarily after wide undermining. Sutures are removed after two weeks. You finally have a choice and can find yourself a perfectly reliable pharmacy to shop with for best medications available: purchase antibiotics online here and see how quick and easy it could be to spend less money.