Pedicled Temporoparietal Fascial Flap Research Articles

Modified pedicled temporoparietal fascial flap combined revascularization in adult moyamoya angiopathy

Pedicled temporoparietal fascial flaps (TPFF), which are flexible, thin, and highly vascularized, have been tried for the moyamoya angiopathy (MMA) treatment. To reduce postoperative complications and improve prognosis, we performed surgical modification and followed up to observe the efficacy. From February 2018 and June 2022, the clinical data of 31 adult MMA patients who underwent the modified TPFF combined revascularization were collected. The clinical outcomes and complications of the patients were recorded until the cut-off date of follow-up. The primary endpoints were the magnetic resonance perfusion (MRP), modified Rankin Scale (mRS) scores, and Matsushima Grade; the secondary endpoints were the clinical symptom outcome and Postoperative complications. Descriptive statistics and rank sum test to assess the therapeutic effect of the modified TPFF combined revascularization for adult MMA treatment. The clinical symptoms of MMA were alleviated in 26 patients and disappeared in five. In all patients, MRP showed improvement in cerebral perfusion on the operated side, and no deterioration or new cerebral infarction occurred during follow-up. Postoperative digital subtraction angiography (DSA) showed that the anastomotic site was patent, and the MMA collateral was decreased in all patients. Only 1 case (3%) of Matsushima grade C showed poor collateral compensation. The admission mRS score (1.54±0.66) of the ischemic MMA was significantly reduced compared with ≥6 months postoperatively (0.54±0.72, P<0.01). The admission mRS score (0.57±0.53) of the hemorrhagic MMA was reduced compared with ≥6 months postoperatively (0, P<0.05). Postoperative complications included epileptic seizures in 2 cases, a cerebral hyper-perfusion syndrome in 2 cases, intracranial rebleeding in 2 cases, skin necrosis in 1 case, and skin maceration in 1 case. Modified TPFF combined revascularization might be a feasible and safe surgical technique for MMA, but it is still necessary to increase the sample size and extend the follow-up time to evaluate its efficacy. Ischemic MMA may have a more significant prognostic benefit than hemorrhagic MMA by this surgery.

Tips and tricks of temporo-parietal fascial flap in post burn ear reconstruction

ObjectivesTemporoparietal fascial flap (TPFF) is one of the most versatile flaps for facial reconstruction. TPFF can be used as a locoregional flap for various indications to provide effective and robust cover. In this article we shall discuss the tips and tricks of TPFF which we have used extensively for post burn ear reconstruction in our clinical experience of more than 20 years with consistent results. MethodsThis is a retrospective review of 497 cases of post burn ear reconstruction using pedicled Temporoparietal fascial flap done at Department of Plastic and Reconstructive Surgery, Lok Nayak Hospital, which is tertiary care Government hospital in New Delhi from March 2000 to March 2020. We started use of this flap initially for ear reconstruction (microtia) cases and slowly expanded our indications over the period of time to post burn ear reconstruction apart from others due to its high vascularity and versatile nature. ResultsWe have used pedicled Temporoparietal fascial flap to our advantage with varied indications and excellent results. We had minor complications which were easily managed with 11 cases of partial flap loss and one case of total flap loss. We shall discuss all the details in our review. ConclusionWe wish to conclude that pedicled Temporoparietal fascial flap (TPF) is an excellent versatile flap which can be easily molded over irregular contours and yields good long-standing results with low complication rates.

Lessons Learned from the Initial Experience with Pedicled Temporoparietal Fascial Flap for Combined Revascularization In Moyamoya Angiopathy: A Case Series

The pedicled temporoparietal fascial flap (TPFF) with a direct superficial temporal (STA) artery to middle cerebral artery (MCA) bypass is a novel combined revascularization approach for moyamoya angiopathy (MMA). With this case series, we aim to report the initial experience with pedicled TPFF combined revascularization for MMA treatment. Data from 14 consecutive patients undergoing pedicled TPFF combined revascularization for MMA between May 2016 and December 2018 were retrospectively reviewed. Patients admitted with acute ischemia or a modified Rankin Scale (mRS) score >3 were considered high risk. Mean ± standard deviation age on surgery was 41.9 ± 15.4 years. Three of 14 patients (21.4%) presented with an mRS score >3. Nine of 14 patients (64.3%) presented with ischemic stroke, 4 of whom (44.4%) had acute ischemia. Direct anastomosis patency was confirmed in all cases postoperatively. Mean hospitalization time was 13 ± 9.3 days and mean follow-up time was 14.1 ± 9.3 months. From admission to follow-up, neurologic status improved in 8 patients (57.1%) and stabilized in 6 patients (42.9%). Overall, 11/14 patients (78.6%) achieved good functional outcome (mRS score ≤2). All patients achieved some radiographic collateral development, with 5 (71.5%) graded as Matsushima A and B. Three patients developed new radiographic ischemia and 3 experienced wound complications, all in the high-risk group. The TPFF combined approach is a viable strategy for revascularization in MMA. This technique may be suboptimal in patients presenting with acute ischemia and/or mRS score >3.

Lessons Learned From the Initial Experience With Pedicled Temporoparietal Fascial Flap for Combined Revascularization in Moyamoya Angiopathy: A Case Series

Abstract INTRODUCTION The pedicled temporoparietal fascial flap (TPFF) with a direct superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass is a novel combined revascularization approach for moyamoya angiopathy (MMA). We aim to report the initial experience with pedicled TPFF combined revascularization for MMA treatment. METHODS Data from fourteen consecutive patients undergoing pedicled TPFF combined revascularization for MMA between May 2016 and December 2018 were retrospectively reviewed. Patients admitted with acute ischemia or a modified Rankin Scale (mRS) score &gt;3 were considered high-risk. RESULTS The median (interquartile range) age was 45.5 (29-56.5) yr. Median mRS score upon admission was 2 (0.8-3.3). Direct anastomosis patency was confirmed in all cases postoperatively. Asymptomatic direct anastomosis occlusion upon follow-up occurred in one case. Median hospitalization time was 12.5 (3.8-18.5) days and median follow-up time was 11.5 (7.8-20) mo. Median mRS upon discharge and at follow-up was 1 (0-4) and 0.5 (0-1.5), respectively. From admission to follow-up, neurologic status improved in 8 (57.1%) and stabilized in 6 (42.9%) patients. Overall, 11/14 (78.6%) patients achieved a good functional outcome (mRS equal or greater than 2). Postoperative Matsushima grades were able to be assigned in 7/14 (50%) patients at a median time of 7.7 (5.3-10.9) mo. All patients achieved some degree of collateral development with 5 (71.5%) of the patients graded as Matsushima A and B. New radiographic ischemia was identified in three patients, all of which were in the high-risk group. Moderate to severe wound complications (3/14) were also limited to the high-risk group. Mild peri-incisional alopecia was found in three (21.4%) patients. CONCLUSION The TPFF combined approach is a viable strategy for revascularization in MMA. This technique may be suboptimal in patients presenting with acute ischemia or those with mRS greater than 3.

Pedicled temporoparietal fascial flap for combined revascularization in adult moyamoya disease.

Moyamoya disease (MMD) is a progressive, idiopathic cerebrovascular occlusive disease. Various revascularization techniques including direct, indirect, and combined microvascular bypasses have been described. This article presents a modified revascularization technique for MMD utilizing a pedicled temporoparietal fascial flap (TPFF) for combined revascularization. This technique combines a large area of coverage for indirect revascularization with the benefits of a direct bypass. The pedicled TPFF also benefits from intact venous drainage to minimize the risk of flap swelling that could result in complications from mass effect.

Evaluation of the sufficiency of pedicled temporoparietal fascial flap on rat head and neck defects: detailed anatomical study

The temporoparietal flap containing the temporal fascia has a wide spectrum of applications in head and neck surgery. The aim of this study is to demonstrate a temporoparietal fascial flap model that can be used in various head and neck defects in rats. Ten male Sprague-Dawley rats weighing 250-300 g were used in this study. Temporoparietal fascial flaps were elevated with the axial pedicle from the rats using microsurgical techniques. The arc rotations of the flaps on the pedicles were examined and the dimensions of the defects these flaps could cover were identified. The flaps were observed to be the right size for use with defects of the occipital, temporal and mastoid regions, ear, facial nerve and the mandible. The temporoparietal fascial flap is an experimental flap model, which can be useful in experimental studies related to complex head and neck defects.

Indirect Cerebral Revascularization With a Temporoparietal Fascial Flap in Pediatric Moyamoya Patients

Moyamoya syndrome is a progressive occlusive disease of the cerebral vessels. There are a variety of surgical treatments directed at revascularizing the ischemic brain in pediatric moyamoya disease. Many reports of varying success with both direct and indirect type of procedures can be found in medical literature. We present a novel technique, encephalo-TPF-synangiosis (ETS) with a pedicled bone flap, for indirect moyamoya revascularization in pediatric patients. A three-quarters osteoplastic temporal craniotomy was created. A pedicled temporoparietal fascial flap was passed intracranially through the temporalis muscle and placed into contact with the pial surface. The bone flap was the reaffixed to the skull. We performed 8 ETS in 6 patients. This is a well-vascularized, highly reliable method that offers broad-based surface area for revascularization. We also offer a composite overview of current surgical indirect revascularization techniques.

Der temporoparietale Faszienlappen zur Rekonstruktion von Weichteildefekten

Soft tissue reconstruction with a temporoparietal fascial flap (TPFF). Defect coverage with thin, pliable, and well-vascularized tissue. A bilayered TPFF provides a gliding surface in tendon reconstruction. Further options include TPFF harvest with overlying skin or subjacent bone for composite tissue reconstruction or the application as a sensate local fascial flap. Maximum defect dimensions: 17 × 14cm. Absolute: prior injury to the flap or flap pedicle, temporal arteritis, Moyamoya syndrome, defects with volume deficit. Relative: alopecia along the planned incision. Pedicle location is outlined using Doppler ultrasound. Injection of the incision line with diluted epinephrine solution. Skin incision with subsequent visualization of the temporoparietal fascia and supplying vessels. Skin flaps are raised carefully paying special attention to the hair follicles (CAVE: postoperative alopecia). Primary closure of the donor site. Defect coverage with pedicled or free TPFF with subsequent full or split-thickness skin grafting. Dressing: Bolster or V.A.C. Immobilization/elevation in the setting of extremity reconstruction. Removal of bolster dressing or V.A.C. on postoperative day5. Dangling protocol instituted on postoperative day7. Removal of sutures/staples at the donor site on postoperative day5-7 and at the recipient site on postoperative day12-14. The TPFF was utilized for soft tissue reconstruction in 8patients. A pedicled TPFF was used in 2patients. Mean time to healing was 16.3days. Mean follow-up was 13.4months. Successful reconstructive results with satisfactory functional and aesthetic appearance were obtained in all patients. Complications were encountered in 3patients and included alopecia at the donor site and iatrogenic injury to the frontal branch of the facial nerve. Vascular compromise was observed in the early postoperative period in a third patient. However, operative revision resulted in successful flap salvage.

Canal Wall—Down Tympanoplasty with Soft-Wall Reconstruction Using the Pedicled Temporoparietal Fascial Flap: Technique and Preliminary Results

We compared the use of the pedicled temporoparietal fascial flap (TPFF) with the use of free deep temporal fascia (DTF) in soft-wall reconstruction after canal wall-down tympanoplasty. In the TPFF group (6 ears), the pedicled TPFF that includes the superficial temporal artery and vein was raised ipsilaterally and rotated into the eradicated mastoid cavity. The tympanic membrane and external auditory canal (EAC) were reconstructed by gluing one side of the TPFF to the mucosal layer of the tympanic membrane and the reverse side of the posterior EAC skin. In the DTF group (21 ears), reconstruction was performed similarly with free DTF. The postoperative period for epithelialization of the tympanic membrane and EAC skin, postoperative complications, and reaeration in the middle ear revealed by computed tomography were reviewed in both groups. In the TPFF group, the mean (+/- SD) period to epithelialization was 25.5 +/- 2.8 days versus 38.4 +/- 12.0 days in the DTF group; the two groups differed statistically (Welch's t-test, p = 0.0002). No postoperative complications occurred in the TPFF group, whereas 2 patients in the DTF group underwent graft necrosis with infection. Three of the 6 patients in the TPFF group showed reaeration not only in the tympanic cavity, but also in the mastoid cavity. However, no statistical differences between the two groups were observed in terms of postoperative complications or reaeration of the mastoid cavity. Our preliminary findings suggest that the pedicled TPFF has positive effects on quick epithelialization. Further prospective studies are needed to reveal the superiority of the pedicled TPFF over free DTF with regard to postoperative infection and recovery of mastoid aeration.

Invited Discussion: Eyebrow Reconstruction With Intermediate Hair From the Hairline of the Forehead on the Pedicled Temporoparietal Fascial Flap

From the Division of Plastic Surgery, The Johns Hopkins Hospital and School of Medicine, Baltimore, Maryland. Received January 2, 2003, and accepted for publication January 10, 2003. Address correspondence and reprint requests to Dr. James E. Vogel, Assistant Professor, Division of Plastic Surgery, The Johns Hopkins Hospital and School of Medicine, 1838 Greene Tree Road, Baltimore, Maryland 21208. Vogel JE. Invited Discussion: Eyebrow Reconstruction With Intermediate Hair From the Hairline of the Forehead on the Pedicled Temporoparietal Fascial Flap.

Eyebrow reconstruction with intermediate hair from the hairline of the forehead on the pedicled temporoparietal fascial flap.

Although various reconstructive procedures for the eyebrow have been reported, few have proved satisfactory for large-tissue defects. The authors describe two cases of eyebrow reconstruction with intermediate hair from the hairline of the forehead on the pedicled temporoparietal fascial flap (TPF flap) after malignant tumor resection. The first patient was a 24-year-old man with an adnexal carcinoma of the left eyebrow. An intermediate hair flap was prepared at the hairline of the forehead in accordance with the defect. The second patient was a 48-year-old woman with Bowen's disease of the left eyebrow. Tumor resection was performed on the frontal muscle with a 5-mm surgical margin. An intermediate hair flap was prepared at the hairline of the forehead in accordance with the defect. Both reconstructed eyebrows have maintained their shapes well. There have been several reports of the use of a TPF flap for eyebrow reconstruction, but none have used intermediate hair from the hairline. The authors are convinced that use of intermediate hair from the hairline of the forehead on the pedicled TPF flap is effective for reconstruction of the eyebrow and large defects extending to nonhairy subbrow skin.

Commentary on: "Reconstruction of full-thickness ear defects using conchal cartilage and pedicled temporoparietal fascia" by Hatoko et al.

The authors should be congratulated for reviewing their experience using ipsilateral conchal cartilage and a pedicled temporoparietal fascial flap in the reconstruction of ear defects of the superior third less than 2 cm in dimension. We agree with the authors that the temporoparietal fascial flap provides reliably vascularized fascia that readily accepts overlying skin grafts and that conchal cartilage will provide a stable skeleton for small auricular defects without creating deformities to the ear. The authors correctly note the problem of obtaining satisfactory color match with grafted skin. Our preference has been the use of postauricular skin on the anterior surface of the ear whenever possible. We make sure and elevate the skin adjacent to the defect and allow the temporoparietal fascia to span beyond the margin of the actual defect. We believe that this helps to minimize the indentation and demarcation between the normal and grafted portion of the reconstruction. The primary aesthetic criteria for auricular reconstruc

Reconstruction of full-thickness ear defects using conchal cartilage and pedicled temporoparietal fascia

We describe method for reconstructing full-thickness ear defects using conchal cartilage graft covered by a pedicled temporoparietal fascial flap with a full-thickness skin graft. We treated eight partial, full-thickness defects of the ear in eight patients, two males and six females. The patients' ages ranged from 10 to 68 years. In five patients, the ear defects were caused by malignant tumor resection (three) and trauma (two). In the remaining three patients, the defect was created after correction of congenital ear deformity (constricted ear). In all cases, the defect included the helical rim and involved the upper third of the ear. The defect size to be reconstructed ranged from 10×14 mm to 16×20 mm. The ipsilateral conchal cartilage could be harvested without any problems in all cases. Grafted skin was obtained from the lower lateral abdomen. In all cases, the blood supply to the fascial flap was good, and the grafted skin took completely. The post-operative course was uneventful in all donor sites for cartilage, temporoparietal fascia, and full-thickness skin. Post-operative shrinkage was not significant and the reconstructed ear was close to the expected contour and size. In all cases, the defects were reconstructed almost completely satisfactorily in terms of contour of the helical rim and support. Although the color match of the grafted skin was not ideal, all patients were satisfied with the results. No donor deformity of the conchal cartilage was found in any case, and the donor scar of the temporoparietal fascia was hidden by the hair. We conclude that the use of conchal cartilage graft and temporoparietal fascial flap with full-thickness skin graft is useful in one-stage reconstruction of medium-sized full-thickness defects of the ear.

The pedicled temporoparietal fascial flap for complex midfacial reconstruction

Reconstruction of the maxillary suprastructure, the periorbital region, and the lateral pyriform aperature are not commonly performed at the time of oncologic ablative surgery. A significant reason for this practice relates to a paucity of local vascularized soft tissue flaps that can support the reconstruction. Because the local soft tissues do not lend themselves to pedicled or rotational transfer, the most commonly used vascularized tissue for midface reconstruction had been the free tissue transfer. In this article, the pedicled temporoparietal fascial flap is described for midface reconstruction. The donor site from the undersurface of the scalp in the posterior temporal and anterior parietal regions permits the development of a highly vascular, durable, and very supple flap. This flap, pedicled on the superficial temporal artery and vein, can be rotated from the preauricular region, under the zygoma, and through the lateral wall of the maxillary sinus into the midface region for use in supporting bone or skin grafts. The temporoparietal donor site also exposes the appropriate area of the calvarium for external table bone grafts, which can be used in maxillary suprastructure replacement. With this flap, the need for microvascular transfer can be reduced or eliminated in those midface defects limited to the maxillary suprastructure, the periorbital region, and the lateral pyriform aperature.

Temporoparietal Fascial Flap in Orbital Reconstruction

To evaluate the success of the temporoparietal fascial flap (TPFF) in the primary or secondary reconstruction of difficult orbital defects and to review the surgical techniques. Retrospective analysis. Tertiary medical center. Nine patients with diverse orbital cavity or periorbital soft tissue and bony defects due to trauma, benign or malignant neoplasms, and radiation treatment. Temporoparietal fascial flap anatomy and techniques of harvest and inset are reviewed in detail. Four cases are presented to illustrate possible variables in orbital reconstruction. Variables examined include the location of defects, the success of flap survival in orbital cavities after primary or secondary reconstruction, the effects of prior irradiation on flap survival, and the possibility of concurrent osteointegrated implant placement with TPFF reconstruction. Functional and aesthetic outcomes were determined by physical examination and preoperative and postoperative photographs. All patients had successful transfer of TPFF grafts without flap compromise. Temporoparietal fascial flap was a viable option for subtle orbital and malar contour defects. In chronically inflamed wounds such as with osteoradionecrosis and orbitoantral fistula, TPFF successfully restored vascularity, obliterated the defects, and enabled the placement of osteointegrated implants. The TPFF also supported the concurrent placement of a free calvarial bone graft. Finally, split-thickness skin grafted onto a pedicled TPFF showed 100% survival. The TPFF is one of the most reliable and versatile regional flaps in the head and neck for orbital reconstruction. This study presents the use of TPFF in a variety of orbital defects, from lateral bony rim defects to total exenteration. Timing of repair in this study spans from immediate reconstruction to reconstruction delayed more than 50 years after the initial injury. In all cases, reconstruction with TPFF resulted in improved bony and soft tissue contours, and incurred minimal morbidity.