Reconstruction Of Various Defects Research Articles

Robotic-assisted free flap harvesting for diverse soft tissue reconstruction: a PRISMA scoping review of clinical outcomes over the last decade.

The aim of our study was to assess the advantages and limitations of robotic technology in diverse reconstructive procedures. A scoping review was conducted in Oct'23, on published studies from 2013 to 2023, focussing on robotic-assisted free flap harvesting. Three databases Ovid-MEDLINE, Scopus, and PubMed were searched. Original research studies reporting robotic-assisted free flap harvest were included. Studies on lesion excision, microvascular anastomosis, local flap harvest, roboticassisted flap inset, review articles, abstract-only studies, non-English documents, and animal studies were excluded from this review. Sixteen studies met the inclusion criteria out of a total of 318, searched initially. These studies included a total of 128 patients, who underwent robotic-assisted free flap harvest for the reconstruction of various defects, with 140 free flaps harvested. The most common flaps harvested by robotic technique were deep inferior epigastric artery perforator (DIEP) flap 120 (85.7%), radial forearm free (RFF) flap 11 (7.9%), latissimus dorsii flap 4 (2.9%), rectus abdominus flap 4 (2.9%), and omental flap 1 (0.7%). Breast reconstruction was the major procedure done i.e. 120 (85.7%) followed by head and neck 11 (7.9%) and limb defects 9 (6.4%) reconstruction procedures. The reported clinical outcomes were acceptable in all the studies with a 99% flap success rate and minimal complications. Variability in operating time was observed depending upon surgical steps undertaken with robotic systems. This scoping review highlights the role of robotic-assisted free flap harvesting in plastic surgery and its potential benefits on clinical outcomes, due to its high precision and minimal invasiveness. However, challenges like cost effectiveness, resource distribution and learning curve are there.

Supraclavicular Artery Flap for Head and Neck Reconstruction

Reconstruction of various defects following head and neck surgery is crucial for restoring both function and aesthetics. Over the years, various flap techniques have been developed to meet these demands. The supraclavicular artery flap is a versatile option readily accessible within the same surgical field during head and neck surgery. Its similarity in texture, color, and contour to the facial region makes it particularly useful for reconstructing defects in the neck and lower face. Additionally, its thin and pliable nature, coupled with a moderate volume, renders it suitable for a wide range of applications, including intraoral defects, pharyngeal defects, and contour refinement in facial surgery. In this paper, we present a method for reconstructing defects in the head and neck region using the supraclavicular artery flap, and discuss its utility, advantages, and limitations.

Modalities of lip reconstruction in facial surgery- A literature review

The authors provide an overview of lip reconstruction of various defects. Lip reconstruction offers unique challenges to preserve not only lip function but also aesthetics. Lip reconstruction must take into consideration the three anatomical layers that comprise the lip and defects that involve the mucosa, the muscle, the skin or more than one layer will help determine the modality of repair. The authors offer an algorithm based on defect location, tissue involvement, and severity of defect to simplify an often complex decision-making process.

Versatility of Radial Forearm Free Flap in Reconstruction of different Defects: A Cross-sectional Study

Introduction: The Radial Forearm Free Flap (RFFF) is a commonly used flap for soft tissue reconstruction, offering several advantages despite sacrificing the radial artery in the forearm. Understanding the anatomy of radial artery perforators, including their distribution, territory, and flow is crucial for reliable and safe flap harvest and design. Aim: To describe the versatility and applications of RFFF in reconstructing defects in various body parts. Materials and Methods: This cross-sectional study was conducted in the Department of Plastic and Reconstructive Surgery at SCB Medical College and Hospital, Cuttack, between January 2019 and January 2021, on 39 cases (age group: 20-70 years) who underwent RFFF. RFFF was utilised for reconstruction of the lip, palate, buccal mucosa, tongue, foot, nose, and phallus. Preoperative evaluation included assessing the vascular status of the non dominant hand using the Allen’s test. Results: RFFF was used for postcancer resection reconstruction in 11 cases of buccal mucosa (28.2%), 7 cases of the lip (17.9%), 6 cases of the tongue (15.3%), 2 cases of the palate (5.1%), 2 cases of phallus reconstruction (5.1%), 1 case of post-traumatic nose defect, and 1 case of 1st web space of the hand (2.5%). In 26 cases of postcarcinoma resection reconstruction, RFFF was used for buccal mucosa, lip, tongue, and palate. The patients were followed up for 2-8 months. Conclusion: RFFF fulfills most of the anatomical prerequisites for an ideal flap, providing a microvascular reconstructive option for patients with large defects in the head and neck, foot and ankle, and phallus. It exhibits a high success rate, good aesthetic and functional outcomes, allowing for the reconstruction of various defects. This study confirms the reliability of the radial free flap as a method for reconstructive surgery.

Robotic-assisted Surgery and its Impact on Patient Outcomes: A Narrative Review

Introduction: The Radial Forearm Free Flap (RFFF) is a commonly used flap for soft tissue reconstruction, offering several advantages despite sacrificing the radial artery in the forearm. Understanding the anatomy of radial artery perforators, including their distribution, territory, and flow is crucial for reliable and safe flap harvest and design. Aim: To describe the versatility and applications of RFFF in reconstructing defects in various body parts. Materials and Methods: This cross-sectional study was conducted in the Department of Plastic and Reconstructive Surgery at SCB Medical College and Hospital, Cuttack, between January 2019 and January 2021, on 39 cases (age group: 20-70 years) who underwent RFFF. RFFF was utilised for reconstruction of the lip, palate, buccal mucosa, tongue, foot, nose, and phallus. Preoperative evaluation included assessing the vascular status of the non dominant hand using the Allen’s test. Results: RFFF was used for postcancer resection reconstruction in 11 cases of buccal mucosa (28.2%), 7 cases of the lip (17.9%), 6 cases of the tongue (15.3%), 2 cases of the palate (5.1%), 2 cases of phallus reconstruction (5.1%), 1 case of post-traumatic nose defect, and 1 case of 1st web space of the hand (2.5%). In 26 cases of postcarcinoma resection reconstruction, RFFF was used for buccal mucosa, lip, tongue, and palate. The patients were followed up for 2-8 months. Conclusion: RFFF fulfills most of the anatomical prerequisites for an ideal flap, providing a microvascular reconstructive option for patients with large defects in the head and neck, foot and ankle, and phallus. It exhibits a high success rate, good aesthetic and functional outcomes, allowing for the reconstruction of various defects. This study confirms the reliability of the radial free flap as a method for reconstructive surgery.

Crane Principle Revisited.

Background:Scalp and forehead defects represent one of the most complex defects for reconstruction. The nature of these sites being hair bearing, together with the complicated nature of the injuries, for example, electrical burns and motor vehicle accidents, and of course the aesthetic concern being in the face, all add to the complexity of reconstruction.Methods:This is a case series representing the experience of the authors in using the “crane principle” in the reconstruction of various defects in the forehead and the scalp presented to emergency department, Cairo University Hospital, for the period between January 2018 and January 2019.Results:Twenty patients, 15 men and 5 women, presented with various soft tissue defects of the forehead and the scalp. The injuries of eighteen patients were due to motor vehicle accidents, and 2 patients had postelectrical burns. Age range was from 20 to 65 years, with a mean follow-up of 8 months. The number of total complications was 5. Three patients had wound dehiscence, and 2 patients had ulceration in the grafts placed at the flap donor site.Conclusion:Crane principle represents an adequate reconstruction tool for forehead and scalp defects especially when the access to free flap and more complex reconstruction techniques is not available.

A prospective study on efficacy of topical bupivacaine in split skin grafting donor site in immediate postoperative pain relief

Objective: The objective of this study was to compare the effectiveness of bupivacaine-soaked gauze dressing and conventional dressing for pain relief in patients requiring split-thickness skin graft for reconstruction of various defects. Methodology: Fifty patients requiring split-thickness skin grafting for various soft-tissue defects were divided into two groups with 25 patients in each group. In Group A, skin graft donor site dressing was kept moist with 10 mL/100 cm2 of 0.25% bupivacaine solution-soaked gauze, and in Group B, dressing was moistened with the same amount of normal saline-soaked gauze. Outcome was measured by comparing pain scores and calculating rescue analgesia requirements in the two groups in the first 24 h. Significance was determined by comparing analgesia-sparing effect of each dressing using Chi-square test. Results: In Group A, 1 out of 25 (4%) patients required rescue analgesia. In Group B, 23 out of 25 (92%) patients required rescue analgesia (P Conclusion: Bupivacaine-soaked dressing should be considered as a potent alternative to traditional saline dressings for the skin graft donor site.

The Anconeus Muscle Free Flap: Clinical Application to Lesions on the Hand.

BackgroundIt can be difficult to select an appropriate flap for various defects on the hand. Although defects of the hand usually must be covered with a skin flap, some defects require a flap with rich blood supply and adequate additive soft tissue volume. The authors present their experience with the anconeus muscle free flap in the reconstruction of various defects and the release of scar contractures of the hand.MethodsTen patients underwent reconstruction of the finger or release of the first web space using the anconeus muscle free flap from May 1998 to October 2013. Adequate bed preparations with thorough debridement or contracture release were performed. The entire anconeus muscle, located at the elbow superficially, was harvested, with the posterior recurrent interosseous artery as a pedicle. The defects were covered with a uniformly trimmed anconeus muscle free flap. Additional debulking of the flap and skin coverage using a split-thickness skin graft were performed 3 weeks after the first operation.ResultsThe average flap size was 18.7 cm2 (range, 13.5–30 cm2). All flaps survived without significant complications. Vein grafts for overcoming a short pedicle were necessary in 4 cases.ConclusionsThe anconeus muscle free flap can be considered a reliable reconstructive option for small defects on the hand or contracture release of the web space, because it has relatively consistent anatomy, provides robust blood supply within the same operative field, and leads to no functional loss at the donor site.

Utility of multi-detector row computed tomography angiography versus Doppler in localization of perforators of anterolateral thigh flaps

Aim: Anterolateral thigh (ALT) flap is widely used in reconstruction of various defects. Preoperative imaging facilitates perforator mapping, overcoming intraoperative uncertainty. The purpose of this study was to investigate the utility of multi-detector row computed tomography angiography (MDCTA) and a handheld Doppler in locating ALT perforators.

Efficacy of Temporalis Myofascial Flap in Maxillofacial Reconstruction

Temporalis myofascial flap holds great promise for the reconstruction of various defects of the maxillofacial region for its dependable blood supply, proximity to the maxillofacial region, possibility to mobilize it to the oral cavity and its fanned out nature. The purpose of the study was to evaluate the efficacy of temporalis myofascial flap in maxillofacial reconstruction.This cross sectional study was carried out in the Department of Oral and Maxillofacial Surgery, Dhaka Dental College and Hospital from January 2011 to December 2011. Nineteen patients (10 male and 9 female), age ranging from 19 to 55 years with medium to large defect (>8cm)were selected for this study. After surgical resection of the pathological lesion, the TMF was exposed by a hemicoronal incision with a preauricular extension. The muscle was rotated to oral cavity and sutured with defect margin. Post-operatively the patient were clinically evaluated at 1, 2, 3 weeks and 1 and 3 months. Complete flap take was observed in 84% cases where as partial flap take was seen in 16% cases. Mouth opening restriction were 2-3 mm in 10 cases and 5-8 mm in 5 cases.Temporalis myofascial flap is a useful, reliable and versatile option for reconstruction of moderate to large sized defects. This flap provide abundant tissue, with minimum to no functional morbidity or esthetic deformity in donor site.J Bangladesh Coll Phys Surg 2014; 32: 78-83

Periorbital Reconstruction With the Expanded Pedicled Forehead Flap

The complexity of structures within the periorbital region makes reconstruction of this area particularly a challenging endeavor. Within the literature, different techniques have been described for reconstruction of the external lamellae of the upper and lower eyelids as well as the medial and lateral canthal regions.Herein, we present the expanded pedicled forehead flap as a versatile and useful surgical option for reconstruction of various defects around the eye globe. A tissue expander is inserted underneath the forehead skin and serially expanded. The pedicle of the expanded pedicled flap is designed either from the superior portion of the expanded skin and interpolated to reconstruct the upper and lower eyelids, and the medial or lateral canthal areas; or from the inferior portion of the expanded skin and interpolated over the eyebrow to reconstruct the area between the upper eyelid crease and eyebrow.Fifteen patients with periorbital nevi or severe scarring were treated using the expanded forehead flap between the years 2003 and 2012. Thirteen patients had complex periorbital defects involving multiple anatomic areas, and 2 patients had defects confined to the upper eyelid area only. Operative and postoperative course for 13 patients was uneventful. One patient had a late infection of the tissue expander but nonetheless continued with the reconstructive process. In 1 patient, the tissue expander was removed due to infection, and subsequent reconstruction was not carried out. The aesthetic and functional results of reconstruction were very good, and with excellent skin color and thickness match. In 1 patient, the flap was defattened in an ancillary procedure. No partial or complete flap loss was observed in this study. We conclude that the expanded pedicled forehead flap is a safe and reliable method for reconstruction of different segments of the periorbital region, while providing good aesthetic and functional reconstructive results with minimal donor-site morbidity.

Vascularized Free Fibula Flap for Reconstruction of Mandibular Defects

Objective: To assess the versatility of vascularized free fibula flap in reconstruction of various defects of mandible. Study Design: Prospective study. Duration of Study: March 2009 to March 2012. Methodology: The study group consisted of 10 patients who underwent resection of mandible for various reasons and reconstruction of continuity defects using a vascularized free fibular flap. The mandible was resected for ameloblastoma in 4 cases, squamous cell carcinoma in 1 case, odontogenic keratocysts in 3 cases and ossifying fibroma in 2 cases. The type of reconstruction performed was primary in 9 patients in which osseous fibula flap was used and secondary in 1 patient in which osseocutaneous flap was used. Results: There were 10 patients which include 5 males and 5 females within age group of 20 to 50 years with mean age of 35 years. All flaps survived except in 1 patient who had donor site morbidity. Flap perfusion was seen immediately after anastomosis and was maintained throughout the follow-up period of minimum 6 months. All patients were kept in nasogastric feeding for 5 days and then began oral feeding and walking with some aid in 2nd week and became completely ambulant in 4th week postoperatively. Conclusion: In our study, we conclude that vascularized free fibula flap is a versatile option for reconstruction of large mandibular defects with its good quality and quantity of bone and ease of manipulation to restore the original anatomy of the mandible and permit implant based prosthetic rehabilitation.

Comparison of bupivacaine moistened dressing and conventional dressing for pain relief on skin graft donor sites.

To compare the effectiveness of bupivacaine moistened dressing and conventional dressing in patients requiring split thickness skin graft for reconstruction of various defects. Randomized controlled trial. Department of Plastic Surgery and Burns Unit, Mayo Hospital, King Edward Medical University, Lahore, from January 2011 to January 2013. One hundred and fifty patients requiring split thickness skin grafting for various soft tissue defects were divided into two groups A and B, with 75 patients in each group. In Group A, skin graft donor site dressing was kept moist with 12 mL/100 cm2 of 0.25% bupivacaine solution and in Group B, dressing was moistened with same amount of normal saline. Outcome was measured by calculating rescue analgesia requirements in the two groups after 24 hours. Significance was determined by comparing analgesia sparing effect of each dressing using chi-square test. In Group A, 5 out of 75 (6.7%) patients required rescue analgesia. In Group B, 72 out of 75 (96%) patients required rescue analgesia (p < 0.0001). There was 93.3% effectiveness of bupivacaine soaked dressing while only 4% effectiveness of conventional dressing. Bupivacaine soaked dressing is much more effective in pain relief and in reducing the requirement of rescue analgesia, in early postoperative period, at split thickness skin graft donor site compared to the conventional dressing.

Plantar reconstruction with free thoracodorsal artery perforator flaps

The plantar region presents unique challenges for reconstructive surgeons. Reconstruction using a thoracodorsal artery perforator (TDAP) flap yields favourable results in various fields of microsurgical reconstruction, but reports on the reconstruction of plantar defects are sparse. Here, the authors present their experience in the reconstruction of various defects in the plantar region using free TDAP flaps. From January 2005 to July 2011, 40 free TDAP flaps were transferred for reconstructive purposes to restore skin and soft-tissue defects in the plantar region. Hospital and outpatient records were reviewed independently for all patients. A patient questionnaire including five questions was administered to subjectively evaluate reconstructive results. A total of 24 male and 16 female patients were enrolled in this study. The mean age was 47.8 years and ranged from 7 to 77 years. The most common cause of defect was oncology related (n=21), followed by trauma-related (n=11), diabetes-related (n=6) and other causes. The average flap size was 63.7 cm2 and ranged from 25 to 212 cm2. All flaps survived except for one, resulting in a below-knee amputation. The mean follow-up period was 20.4 months. Four patients underwent secondary revisional procedures, including simple defatting in two patients and excision of redundant skin due to flap instability in two patients. The satisfaction surveys were completed by 34 (85%) patients. Patients reported high levels of satisfaction in terms of pain, limitation of daily activities, donor site satisfaction and overall satisfaction. Most patients were satisfied and reported that they would recommend the procedure to others. An appropriately thinned free TDAP flap with thick skin provided favourable outcomes with high patient satisfaction and is a valuable option for the restoration of skin and soft-tissue defects in the plantar region.

Evaluation of Diagnostic Accuracy Using Preoperative Handheld Doppler in Identifying the Cutaneous Perforators in the Anterolateral Thigh Flap

Sir:FigureThe anterolateral thigh flap has become a workhorse flap in the reconstruction of various defects. Because of its variable vascular geometry, preoperative assessment of perforators has been performed with several devices.1 The handheld Doppler probe is noninvasive and also the least expensive and the easiest to use of the devices available. Mapping of the cutaneous perforators with a handheld Doppler probe before flap design has been advocated extensively. However, handheld Doppler examination is reported to be relatively unreliable in determining the exact site of the underlying perforators.2,3 A systematic review was performed for trials comparing handheld Doppler imaging with perioperative findings as a reference standard. We searched the PubMed database from January of 2000 to December of 2010. We used the following keywords: “anterolateral thigh flap” and “handheld Doppler.” Two reviewers independently extracted data in two steps: titles and abstracts, and then the full text articles. This search was supplemented by a review of reference lists of potentially eligible studies. We excluded studies from which a 2 × 2 table could not be formed. We extracted available data on true-positives, false-negatives, false-positives, and true-negatives for detecting the location of anterolateral thigh perforators with the handheld Doppler probe to construct 2 × 2 contingency tables.4 There were three eligible studies containing 224 test results (Table 1). When the data from handheld Doppler imaging were compared with the perioperative findings, the sensitivity was 89.7 percent (95 percent confidence interval, 85.0 to 93.0 percent) and the specificity was 18.2 percent (95 percent confidence interval, 8.6 to 34.4 percent). Handheld Doppler imaging has a positive predictive value of 88.1 percent (95 percent confidence interval, 83.8 to 92.2 percent) and a negative predictive value of 20.7 percent (95 percent confidence interval, 6.2 to 35.8 percent).Table 1: Results of Handheld Doppler StudiesThe positive likelihood ratio is 1.097 (95 percent confidence interval, 0.928 to 1.296) and the negative likelihood ratio is 0.565 (95 percent confidence interval, 0.249 to 1.283). The diagnostic odds ratio with handheld Doppler between the presence of anterolateral thigh perforator versus absence was 1.942 (95 percent confidence interval, 0.726 to 5.196). The accuracy of handheld Doppler is 80.5 percent (95 percent confidence interval, 75.7 to 85.4) (Table 2).Table 2: Pooled Results of Test Indicators of Handheld Doppler Studies*The authors conclude that handheld Doppler is a simple, easy, but not always accurate method for the localization of anterolateral thigh perforators. Mapping and design of the anterolateral thigh flap should not rely completely on handheld Doppler findings. Hsu-Tang Cheng, M.D. Department of Plastic Surgery, China Medical University Hospital, School of Medicine, China Medical University, Taichung, Taiwan Fu-Yu Lin, M.D. Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan Sophia Chia-Ning Chang, M.D., Ph.D. Department of Plastic Surgery, China Medical University Hospital, School of Medicine, China Medical University, Taichung, Taiwan DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Versatile use of the muscle and nerve sparing latissimus dorsi flap

In this report, we describe the technique of muscle and nerve sparing latissimus dorsi (LD) flap and evaluate the outcomes of reconstruction of various defects with 12 free and 2 pedicled muscle and nerve sparing LD flaps in 14 patients. The LD muscle functions at operated and nonoperated muscles were evaluated clinically and with electroneuromyography. All flaps survived completely but one which had a partial necrosis. The mean follow-up time was 12.3 months. Adduction and extention ranges of the shoulders were the same bilaterally in all patients. In electroneuromyography, no significant difference was available statistically between the sides. This muscle and nerve sparing latissimus dorsi flap has advantages of thinness, muscle preservation and reliability, and thus can be a good option to other fasciocutaneous flaps in reconstruction surgery.

Safety and reliability of microsurgical free tissue transfers in paediatric head and neck reconstruction – a report of 72 cases

Although many large series of free tissue transfers for head and neck reconstruction have been reported in adults, there are few studies in paediatric patients. Seventy-three free tissue transfers for reconstruction of various defects of the head and neck were performed in 72 paediatric patients between January 1990 and September 2002, at our centre. The average age at the time of reconstruction was 11.8 years (range: 2 to 17 years). Thirty-eight patients were girls and 34 were boys. There were 19 tumour resection defects, 18 congenital oro-nasal fistula defects (cleft palate), 11 posttraumatic defects, nine corrosive pharyngo-oesophageal injuries, eight burn contractures, six hemifacial atrophies and microsomia, and one facial paralysis. Thirty-nine fasciocutaneous flaps, 16 osteoseptocutaneous flaps, 10 muscle or myocutaneous flaps, and eight jejunal flaps were transferred. The mean operative time was 8 h 20 min. All flaps survived, except one partial necrosis, with 98.6% success rate. Five patients (6.8%) required re-exploration. There were two venous and three arterial thromboses. All five flaps were successfully salvaged. The average hospital stay was 18 days. This study confirmed free tissue transfer as a safe, reliable, cost- and time-effective method for the reconstruction of various head and neck defects in children.

Lateral intercostal artery perforator-based reverse thoracic flap for antecubital reconstruction

Pedicled flaps distant from the trunk are often used to reconstruct defects of the upper extremity. For this, various flaps have been described, with the groin flap being the most common. Recently, perforator flaps and perforator-based pedicled flaps have been described, that can be raised from the trunk for reconstruction of various defects. The lateral intercostal artery perforator (LICAP) flap, raised from the lateral and posterior thorax, has been used for chest reconstruction. Also LICAP flaps from the abdominal area were described in reconstruction of the upper extremity. In this paper we report a case where a LICAP-based thoracic flap was used for the reconstruction of the antecubital area of the upper extremity. This is the first report of the application of this flap to the upper extremity. The advantages of reverse LICAP flap from the posterolateral thoracic area are: (1) no kinking in the pedicle as it is not folded, especially for antecubital defects, (2) hairless skin from the midaxillary line area, (3) thinner flap compared to the abdominal area and (4) the scar is on the back of the patient in a more acceptable area.

The utility of the temporalis muscle flap for oropharyngeal, base of tongue, and nasopharyngeal reconstruction

To determine the efficacy of temporalis muscle flap reconstruction of various defects of the oropharynx, nasopharynx, and base of tongue. Retrospective chart review of a consecutive series of 24 patients who underwent a total of 26 temporalis flaps (2 bilateral) by the senior author (Y.D.) from September 1997 to August 2003 for reconstruction of defects of the oropharynx, nasopharynx, and base of tongue. Variables and outcomes that were examined included defect location, size, adjunctive therapy, complications, and ability to tolerate oral intake at follow-up. There was no evidence of flap failure in our series of patients. There were 2 cases of minor flap loss related to early prosthetic rehabilitation. Two cases of transient frontal nerve paralysis were noted. A 30.8% rate of complication (all minor) was noted in this study. At a mean follow-up of 12 months, 54.2% of patients were tolerating a full diet, 37.5% were tolerating most of their nutrition by mouth, and 8.3% were g-tube dependent. The temporalis muscle flap represents an excellent alternative in reconstruction of otherwise difficult-to-reconstruct defects of the nasopharynx, oropharynx, and base of tongue. Donor site aesthetics are well accepted by patients with primary hydroxyapatite cement cranioplasty with or without secondary lipotransfer.

Versatility of temporalis myofascial flap in maxillofacial reconstruction—analysis of 30 cases

Abstract.Temporalis myofascial flap holds great promise for the reconstruction of various defects of the maxillofacial region—either congenital or surgical. The dependable blood supply through the middle and deep temporal arteries, proximity to the maxillofacial region, possibility to mobilize it to the oral cavity through the under surface of zygomatic arch and its fanned out nature permits the surgeon to use this flap for the reconstruction of various maxillofacial defects and even as an interposing tissue. In this series of 30 cases, we have used the temporalis myofascial flap for the reconstruction of different types of maxillofacial defects and as an interposing material in TMJ surgeries. We found that this flap is very valuable in maxillofacial reconstruction.