Superficial Temporal Artery Perforator Flap: Indications, Surgical Outcomes, and Donor Site Morbidity

Raffaele Rauso,Carmelo Lo Faro,Giovanni Francesco Nicoletti,Giorgio Lo Giudice,Romolo Fragola,Enrico Sesenna,Gianpaolo Tartaro,Fabrizio Chirico

doi:10.3390/dj8040117

Abstract

The aim of this retrospective case series was to discuss indications, surgical outcomes, and donor site morbidity in the use of superficial temporal artery perforator (STAP) flaps in intra-oral or extra-oral facial reconstruction. This study involved 9 patients treated with a STAP flap at the Maxillo-Facial Surgery Unit of the University of Campania “Luigi Vanvitelli”, Naples. A STAP flap was used alone or in combination with other local flaps, for the coverage of facial soft tissue defects, after the resection of craniofacial malignant tumors (n = 7) or as a salvage flap, in partial or total microvascular flap loss (n = 2). The STAP flap was proven to be a valuable surgical option despite it not being frequently used in facial soft tissue reconstruction nor was it chosen as the first surgical option in patients under 70 year’s old. Donor site morbidity is one of the major reasons why this flap is uncommon. Appropriate patient selection, surgical plan, and post-surgical touch-ups should be performed in order to reduce donor site scar morbidity.

Highlights

The first goal in facial reconstruction is anatomical repair while respecting the aesthetic units [1].Facial reconstructive procedures are extremely heterogenous and can be tailored on the basis of the location and the size of the defect [2]
A primary indication for superficial temporal artery perforator (STAP) flap was given only in the case of defects involving the ear (Case 2), in an old patient with poor clinical conditions (Case 7), and in one case who had a small defect where a direct skin closure of the donor site was achievable without significant eyebrow asymmetry (Case 8)
In 3 patients, this flap was used because of neck depleted vessels (Case 3, Case 6, and Case 9), in 2 patients it was used as a salvage procedure of partial microsurgical flap failure (Case 1 and Case 5), and in 1 patient it was used as a second flap, associated with a radial forearm free flap, following maxillary cancer demolition (Case 4)

Summary

Introduction

The first goal in facial reconstruction is anatomical repair while respecting the aesthetic units [1].Facial reconstructive procedures are extremely heterogenous and can be tailored on the basis of the location and the size of the defect [2]. Several surgical techniques for intra-oral and extraoral facial defects can be performed, including free flaps [3], local and rotational flaps [4], pedicle flaps [5], and skin grafts [6], scar quality and donor site morbidity must be carefully evaluated in the pre-operative planning. Free flaps such as free radial forearm or anterolateral thigh perforator flap, when possible, always represent the first choice [7].

Objectives

Methods

Discussion

Conclusion