Superficial Temporal Artery Flap Research Articles

The Role of CT Angiography in Designing a Hair-Bearing Superficial Temporal Artery Flap for Eyebrow Reconstruction.

The hair-bearing superficial temporal artery flap is one of the traditional options for total eyebrow reconstruction. The anatomical variation of the superficial temporal artery has been well discussed; however, the anatomy of the superficial temporal vein is highly diverse. The authors report the use of preoperative computed tomography (CT) angiography in a 27-year-old man with a total eyebrow defect caused by thermal burn injury. The authors harvested a 6×1.5-cm pedicled hair-bearing superficial temporal artery flap from the area where the parietal branches of the superficial temporal artery and vein were running in close proximity, according to the CT angiography findings. Postoperatively, the flap survived completely without any vascular compromise. The authors believe that preoperative visualization of the superficial temporal vessels with CT angiography is highly beneficial in performing safe eyebrow reconstruction with a hair-bearing superficial temporal artery flap.

Reconstruction of Large Cervicofacial Defects With Expanded Island Superficial Temporal Artery Flaps and an 810-nm Diode Laser Hair Removal Technique.

Extensive cervicofacial reconstruction is challenging for plastic surgeons. Because of the location of the adjacent scalp flap nourished by the superficial temporal artery (STA), it can be a candidate for cervicofacial reconstruction. This article aims to report a combined treatment of an expanded island STA flap and an 810-nm diode laser hair removal technique for extensive cervicofacial defects. Between January 2015 and December 2018, 10 patients with lower face and neck scar contraction were reconstructed with a bilateral or unilateral expanded STA island flap and an 810-nm diode laser for hair removal in this retrospective study. Hair removal via the 810-nm laser was started when the injected volume reached the volume of the expander, with a fluence of 35 to 40 J/cm2 and a 1 to 2 Hz repetition rate. Before second-stage surgery, the hair reduction rate was assessed. Twelve months after surgery, the degree of epilation efficacy according to the satisfaction scale and Global Aesthetic Improvement Scale was evaluated. This study included 2 single-pedicle flaps and 8 double-pedicle flaps. The average size of the implanted expanders was 600 mL. The average injected volume was 1405 mL. Before second surgery, there was a 67.4% hair reduction rate. Twelve months after surgery, the results of Global Aesthetic Improvement Scale were very good (3), good (6), average (1), and poor (0). The expanded island STA flap and 810-nm diode laser technique may be a novel treatment option for severe face and neck aesthetic reconstruction.

Repair of Defects in the Scalp and Face With Expanded Superficial Temporal Artery Flaps: A Single-Center Retrospective Study.

Defects resulted from the removal of large scars, benign tumors, severe pigmentation abnormalities, and vascular malformations, etc., in the scalp and face need to be repaired to restore the appearance. Here, the authors introduced the application of various expanded superficial temporal artery (STA) flaps in the repair of above defects. From Jan. 2015 to Dec. 2018, 19 patients with craniofacial secondary defects received the repair with expanded STA flaps in our clinic. The defects were resulted from the removal of scalp scar (n = 6), neurofibroma (n = 4), sebaceous nevus (n = 3), arteriovenous malformation (n = 2), facial scar (n = 2), and port-wine stain (n = 2). The expanded STA flaps included 14 cases of flaps pedicled by parietal branch of STA, 2 cases of flaps pedicled by parietal branch of STA combined with laser hair removal, 1 case of flaps pedicled by frontal branch of STA, and 2 cases of prefabricated expanded skin flap with the superficial temporal fascia in the neck. The two-stage operation and water-filling expansion were accomplished in all patients. All flaps survived well, except one flap with venous congestion, which resolved after blood-letting and application of drugs promoting venous draining. In the three to six months follow-up, the flaps' color, texture, and thickness were satisfying. Individual application of different types of expanded STA flaps could achieve ideal results in repairing craniofacial secondary defects.

One Pedicled Superficial Temporal Artery Hair-bearing Flap to Reconstruct Three Different Anatomical Areas of the Burnt Face: A Personal Technique.

Reconstruction of the burnt face is a challenge. In men, the best option to hide facial scars and get rid of the grafted facial appearance is to use the superficial temporal artery hair-bearing flap. In the literature, the superficial temporal artery flap hair-bearing flap has been used to reconstruct one facial anatomical area in men such the eyebrows, the beard, or the mustache area. In this communication, the author describes a personal technique that allows the use of one pedicled superficial temporal artery hair-bearing flap to reconstruct both eyebrows and improve the grafted appearance of the upper/lower lips post the release and graft of burn contractures. The technique will be demonstrated by a case presentation.

Three End-to-End Techniques for Microvascular Anastomosis of Vessels With Different Size Discrepancy.

Size discrepancy in microvascular anastomosis is a common issue in free flap transfer and replantation surgery. A number of different techniques have been described to overcome the problem, but optimal method continues to be defined. Since June 2015 to May 2018, clinical courses of 103 microvascular cases performed by one senior surgeon were reviewed. Three end-to-end techniques including mechanical dilation, single-mattress suture, and wedge resection were applied in 364 anastomoses with caliber ratio between 1:1 and 1:1.5, 1:1.5 and 1:2, and 1:2 and 1: 3, respectively. A total of 112 flaps were incorporated in this study. The incidence of anastomotic failure was 3.0% (11/364), and the overall flap failure rate was 3.6% (4/112). The failure cases included 2 replanted scalps, 1 replanted ear, and 1 superficial temporal artery flap for nasal reconstruction. Our results depicted operational convenience and reliability of the 3 end-to-end anastomotic techniques in addressing mild-to-large vessel discrepancy.

Application of Superficial Temporal Artery Flap in Wound Repairing After the Resection of Craniofacial Malignant Tumors.

Craniofacial malignant tumors require not only extended resection but also appropriate reconstruction to restore appearance, which remains a major challenge. Here the authors introduced the application of superficial temporal artery (STA) flap in wound repairing after the resection of craniofacial malignant tumors. From January 2015 to December 2018, 16 patients with craniofacial malignant tumors were enrolled into the study, including squamous cell carcinoma (n = 6), basal cell carcinoma (n = 3), melanoma (n = 4), neuroendocrine carcinoma (n = 2), and dermatofibrosarcoma protuberance (n = 1). All of the tumors underwent extended resection. The defects formed were repaired by flaps pedicled with superior or frontal branch of STA. Donor sites were repaired with skin grafts. Patients were followed up for 6 months to 3 years to monitor the recurrence of tumor. All the flaps survived well. Venous congestion occurred in two cases but resolved after blood-letting and application of drugs promoting venous draining. During the follow-up, no recurrence of tumors was observed and the appearance of flaps was satisfying. But flap donor sites suffered from relatively poor appearance or alopecia deformity. The STA flap is reliable for wound repairing after resection of craniofacial malignant tumors. The STA parietal branch flap is preferred for repairing scalp defects, while the STA frontal branch flap is preferred for repairing facial defects. However, the STA flap should be used prudently due to its disadvantage of the deformity in scalp donor sites.

Full-thickness total upper eyelid reconstruction with a lid switch flap and a reverse superficial temporal artery flap

Reconstruction of the upper eyelid with the same eyelid tissue is desirable because of the ability to achieve eye opening/closing and corneal protection, and a lid switch flap is a useful method. For total defects, almost all of the tissues of the lower eyelid should be used; however, the reconstruction of the lower eyelid donor site has often been undervalued. Reconstruction with an insufficient amount of soft tissue often results in complications such as lagophthalmos and ectropion. Here, we report our method of management of total upper eyelid defects and secondary reconstruction of the lower eyelid donor site. A lid switch flap is designed on the lower eyelid as the first operation. As important points, the height of the flap of the anterior lamina should be the same but the conjunctiva as the posterior lamina should be harvested up to the conjunctival fornix to obtain sufficient tissue. After switching the flap, the lower eyelid donor site is reconstructed with sufficient tissue: cheek mucosa, conchal cartilage, and a reverse superficial temporal artery flap as a three-layered structure. Three patients were treated using our method, and we achieved favorable results with a sufficient amount of soft tissue for the reconstruction of the lower eyelid. Reconstruction of the upper eyelid with sufficient tissue from the lower eyelid is important for eyelid function.

Hand Doppler flowmetry for surgical planning of pedicled flap in extensive full-thickness scalp reconstruction

Reconstruction of scalp defects can be performed with local flaps for medium to large defects (2–25 cm2) and microvascular free flaps for extensive full-thickness scalp reconstruction greater than 25 cm2. Doppler flowmetry with its ability to exactly mark the course of arteries on the overlying skin, is a useful tool for the surgical planning of large local flaps. In our retrospective study conducted on 38 patients (all patients had malignancies or post-traumatic scalp defects), consisting of 39 total surgical procedures, we studied the impact of doppler ultrasonic flowmetry in the surgical planning for pedicled flaps in extensive full-thickness scalp reconstruction (>25 cm2) by evaluating overall flap survival rate. Nine different types of local flaps were employed in the scalp reconstruction: Superficial temporal artery (STA) pedicled rotation flap, STA pedicled transposition flap, STA islanded flap, bipedicled STA flap, bipedicled fronto-occipital flap, Supraorbital/Supratrochlear artery rotation flap, Supraorbital/Supratrochlear artery transposition flap, Occipital artery (OA) pedicled rotation flap, OA pedicled transposition flap. Before each surgical procedure a hand held doppler Huntleigh Diagnostic flowmeter with a 8 MHz probe was used to identify and follow the course of the arteries. Flap survival rate was 100%. No postoperative complications related to the flap were reported, while in two patients a partial skin graft failure occurred.

Supermicrosurgical reconstruction of nasal tip defects using the preauricular reversed superficial temporal artery flap

Microsurgical reconstruction of nasal tip defects is difficult to achieve. The free composite auricular flap allows for repair in a one-stage procedure. However, anastomosis to the recipient facial artery is often complicated because of its variable anatomy and the need for a vessel graft. In this study, we describe our experience using the alar artery and angular vein as recipient vessels for direct super microsurgical anastomosis. From February 2004 to December 2015, thirty-two patients with different degrees of full-thickness multi-subunit nasal tip defects were included in this study. The superficial temporal vessels, alar artery, and angular vein were marked preoperatively by ultrasound detection. The preauricular reversed superficial temporal artery flap was harvested and transferred to the nasal tip defect region as a free flap using a supermicrosurgical technique. Patient pictures were taken before surgery and at 1, 3, and 6 months of follow-up. Outcomes and complications were recorded and analyzed. Moreover, a postoperative patient satisfaction survey was performed. The reversed superficial temporal artery flap was used in a total of 32 patients for the reconstruction of nasal tip defects in a one-stage procedure. In all cases, the alar artery and angular vein showed no anatomical variations and were used as recipient vessels. The size of the harvested preauricular flap size was 2.5×2.0 to 4.0×3.6cm2, and the average flap size was 3.6×2.7cm2. The length of the arterial pedicle was 4.0 to 6.7cm, 5.58cm on average. The length of the venous pedicle was 5.0 to 6.8cm, 6.21cm on average. Direct anastomosis was achieved in all patients, and in none of the cases, a vascular graft was needed. Donor sites were all closed primarily. Flap survival was complete, except for one case of vascular thrombosis, resulting in a 10% flap necrosis. Temporary hematoma was noted in one patient. The postoperative outcome showed excellent functional coverage and improved esthetic appearance. The average follow-up period was 12 months. The majority of patients (98.5%) rated their postoperative outcome as highly improved and improved. No late recurrence or other complications were seen in any of the patients. Twenty-two patients underwent a secondary debulking procedure of the flap for fine adjustment. Our results demonstrate that the alar artery and angular vein are suitable recipient vessels for the super microsurgical reconstruction of nasal tip defects. Surgical planning and procedure are facilitated by their reliable anatomy without the need for a vessel graft. This technique may offer wider applications by extension to other facial cutaneous defects.

Venous Congestion in Pedicled Frontal Branch Superficial Temporal Artery Flaps Reconstructions for Head and Neck Defects: A Review.

The superficial temporal artery (STA) flap is a versatile flap for head and neck defect reconstruction. It can be based on the frontal branch of the STA and an islanded 360-degree rotation arc for various defects on the scalp, cheek, and auricular region. It provides a nonmicrosurgical option for reconstructing such defects, which is itself relatively easy to perform. However, venous congestion is a problem than often can cause worry to the clinician and hence preclude its use. In this review, we revisit this flap in head and neck reconstruction, with case examples used for reconstruction of defects on the scalp, maxilla, lip, ear, and retroauricular area. The STA flap in our review can be used either as a fasciocutaneous flap or with its fascia alone. The main issue with the STA flap is that it is generally a high-inflow flap with variable outflow. Venous congestion is frequently encountered in our practice, and adequate management of the venous drainage in the postoperative period is crucial in ensuring its success as a versatile and viable option for head and neck reconstruction.

Surgery for congenital aural atresia using a superficial temporal artery flap

Surgery for congenital aural atresia using a superficial temporal artery flap

Superficial temporal artery flap for reconstruction of complex facial defects: A new algorithm.

BackgroundA variety of island flaps can be based on the superficial temporal artery with variable tissue composition. They can be used for defect reconstruction, cavity resurfacing, facial hair restoration, or contracture release.MethodsSeventy-two patients underwent facial reconstruction using a superficial temporal artery island flap from October 2010 to October 2014. The defects had various etiologies, including trauma, burns, tumors, exposed hardware, and congenital causes. We classified the patients by indication into 5 groups: cavity resurfacing, contracture release, facial hair restoration, skin coverage, and combined. The demographic data of the patients, defect characteristics, operative procedures, postoperative results, and complications were retrospectively documented. The follow-up period ranged from 24 to 54 months.ResultsA total of 24 females and 48 males were included in this study. The mean age of the patients was 33.7±15.6 years. The flaps were used for contracture release in 13 cases, cavity resurfacing in 10 cases, skin coverage in 17 cases, facial hair restoration in 19 cases, and combined defects in 13 cases. No major complications were reported. Conclusion: Based on our experiences with the use of superficial temporal artery island flaps, we have developed a detailed approach for the optimal management of patients with composite facial defects. The aim of this article is to provide the reader with a systematic algorithm to use for such patients.

Divided and Sliding Superficial Temporal Artery Flap for Primary Donor-site Closure.

Summary:Superficial temporal artery (STA) flaps are often used for reconstruction of hair-bearing areas. However, primary closure of the donor site is not easy when the size of the necessary skin island is relatively large. In such cases, skin grafts are needed at the donor site, resulting in baldness. We have solved this issue by applying the divided and sliding flap technique, which was first reported for primary donor-site closure of a latissimus dorsi musculocutaneous flap. We applied this technique to the hair-bearing STA flap, where primary donor-site closure is extremely beneficial for preventing baldness consequent to skin grafting. The STA flap was divided into 3, and creation of large flap was possible. Therefore, we concluded that the divided and sliding STA flap could at least partially solve the donor-site problem. Although further investigation is necessary to validate the maximum possible flap size, this technique may be applicable to at least small defects that are common after skin cancer ablation or trauma.

Abstract: Our Concept for Reconstruction of a Full-Thickness and Total-Width Defect of the Upper or Lower Eyelid

INTRODUCTION: As the elderly population continues to expand, the number of patients with skin cancer is increasing. Several types of carcinoma can occur in the eyelid. Because the range of the eyelid is narrow, the defect after malignant tumor resection is likely to be full-thickness and total-width defect. Several procedures have been reported for those large defects and they vary according to the facility. We describe here our method method for reconstruction of a full-thickness and total-width eyelid defect. METHODS AND RESULTS: Our treatment policy for a full-thickness and total-width eyelid defect is the use of an appropriate reconstruction material that matches the structure of the eyelid. A three-layered structure consisting of a skin flap, cartilage and mucosa, which correspond to the skin and subcutaneous tissue, tarsus and conjunctiva of the eyelid, respectively, is used for reconstruction. For the lower eyelid, if dermatochalasis of the upper eyelid is severe and there is excessive skin, an orbicularis oculi musculocutaneous flap is preferred for reconstruction of the anterior lamella. If the surrounding skin is not sufficient, a reverse superficial temporal artery (STA) flap is used1. The posterior lamella is reconstructed with a conchal cartilage graft and oral mucosa graft. However, for the upper eyelid, we use a lid switch flap as the primary method2, which is the best method both functionally and aesthetically. The lower eyelid donor site is reconstructed as described. Reconstruction using our method was carried out in seven patients. No major complications were seen during the follow-up period. CONCLUSION: A sufficient amount of soft tissues is an essential condition for either upper or lower eyelid reconstruction. If the eyelid is reconstructed with an insufficient amount of soft tissues, complications such as ectropion or drooping are likely to occur because to irresistible contracture, and such complications would cause pain for the patient. We have been performing eyelid reconstruction using a three-layered structure with an adequate amount of tissues, and our method provides functionally and aesthetically excellent results. DISCLOSURE/FINANCIAL SUPPORT:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. REFERENCES: 1. Yamauchi M, Yotsuyanagi T, Yamashita K, Ikeda K, Urushidate S, Mikami M. The reverse superficial temporal artery flap from the preauricular region, for the small facial defects. J Plast Reconstr Aesthet Surg. 2012;65:149–55 2. Mustarde JC. Reconstruction of eyelids. Ann Plast Surg. 1983;11:149–69

Surgical management of Oral submucous fibrosis

Background: Oral submucous fibrosis (OSF), globally accepted as an Indian disease, has one of the highest rates of malignant transformation amongst potentially malignant oral lesions and conditions. The hallmark of the disease is submucosal fibrosis that affects most parts of the oral cavity, pharynx and upper third of the esophagus leading to dysphagia and progressive trismus due to rigid lips and cheeks. Nonsurgical measures like local steroids, hyaluronidase injections, vitamin supplements and jaw opening exercises have poor results. There lack of guidelines for choosing the surgical procedures. Methods: This prospective study was done on 13 cases of clinically diagnosed oral submucous fibrosis during 2012-2015. After diagnosis these patients are grouped according to the severity of the disease proposed by Chandramani More. The patients underwent either release and split skin grafting or Nasolabial flap or Superficial temporal artery fascial flap for intra oral cover. The results were analysed for postoperative mouth opening and complications. Results : Of the total 13 patients studied 8 were male and 5 females. The age ranged from 22 years to 68 year (Mean= 43 years). Preoperative functional stage was ten patients 15-25mm mouth opening (M3) and three patient <15mm mouth opening (M4) Mean preoperative mouth opening was 16.7mm. The procedure performed was release with split skin graft in six patients, release with Nasolabial flap cover in two patients and release with superficial temporal artery flap cover with graft in five patients. Mean post operative mouth opening was 35.6mma at follow up of 6 months. Conclusion : Surgical correction of oral submucous fibrosis offer better outcome than conservative management. The choice of surgical procedure depends on patient profile. Flap covers are better than split skin graft in term of recurrances. Nasolabial flap cover can be used in elderly with lax skin. The superficial temporal artery fascial flap cover has advantage of lesser morbidity and more suited in cases of severe restriction of mouth opening.

Repairing Facial Soft Tissue Defects by Swelling Anesthesia after Tumor Resection with Narrow Pedicle Flaps.

To investigate the role of swelling anesthesia in repairing facial soft tissue defects after tumor resection and temporal superficial artery frontal branch of narrow pedicle flap. From January 2008 to June 2008, 16 patients from Department of Ophthalmology with eye or eyelid tumors after eyeball removal of eye and part resection of surrounding soft tissue, undergoing postoperative swelling anesthesia with superficial temporal artery flap repair to prevent facial soft tissue defect formation and bone exposure, were recruited. In all 16 patients facial soft tissue defect repair had good effects, with limited bleeding, and short operation times. Seven days after surgery, all flaps were in good repair. On postoperative follow-up after 3 months, flaps showed a similar appearance as with facial tissue. Swelling anesthesia for superficial temporoparietal artery frontal branch of narrow pedicle flap to repair soft tissue defect after facial tumor resection is feasible, and is linked with good analgesic effects, high postoperative survival of skin flaps, and good cosmetic effects.

The reverse superficial temporal artery flap from the preauricular region, for the small facial defects

For the reconstruction of facial defects, the retroauricular flap is generally used. However, this flap has disadvantages, such as venous return disturbance and reddish skin colour peculiar to the retroauricular region. Here, we report the reverse superficial temporal artery (STA) flap, elevated from the preauricular region. In our method, the flap is retrogradely elevated including the STA under the skin island in the preauricular region and the temporoparietal fascia around the superficial temporal vessels in the temporal region. The donor site is closed primarily or by the retroauricular flap. Five cases with a pedicled flap and one case with a free flap were treated using our method. In one case, a minor congestion of the flap occurred postoperatively, and temporary facial nerve palsy in another case. In all cases, the results were cosmetically good, and the scar at the donor site was inconspicuous. As compared to the retroauricular flap, our method is easier to perform and the flap has a reliable blood circulation. Moreover, it can be used with both a pedicled and a free flap, leaving an inconspicuous scar at the donor site, and a colour match without reddish skin. Therefore, when considering reconstruction of small-sized defects on the face, our method is more useful than the retroauricular flap.

Superficial temporal artery flap: a new option for posterior hypopharyngeal wall reconstruction

Reconstruction of hypopharynx after tumor resection remains a challenging problem for the head and neck surgeons. A new surgical technique was introduced to reconstruct the hypopharynx after tumor resection using the superficial temporal artery flap. Three patients with T3 carcinoma of the posterior hypopharyngeal wall who underwent surgical resection of the tumor with laryngeal preservation were reported using this method. The larynx functions were preserved successfully in all the patients. In all patients, the nasogastric tubes were removed within 20-50 days (mean 33 days). The tracheal tubes were plugged on days between 14 and 44 (mean 26th day) postoperatively. Then all patients received the postoperative radiotherapy. The tracheal tubes were removed successfully 5-7 months after surgery (mean 6 months) without the evidence of apnea. The speech function was excellent in all patients, which was evaluated according to the voice-related quality of life questionnaire. Although lymph node metastasis was detected in one patient 6 months after surgery, there were no evidences of flap complications in all the three patients. The superficial temporal artery flap is a new option for the posterior pharyngeal wall reconstruction in selected cases with the hypopharynx carcinoma. The larynx functions were preserved successfully.

Some Results of Our Research on Composite Facial Allograft Transplantation in Dogs

Composite facial allograft transplantation is a complicated surgical procedure, requiring evaluation of several questions. How should the facial allograft be preserved? What are the proper surgical skills to reduce surgery duration? Can composite facial allograft transplantation rebuild the motor functions of the facial muscles? In our research, University of Wisconsin (UW) solution was used to preserve canine facial tissue. We manipulated the surgical procedures of complete facial allograft transplantation on cadavers to improve surgery skills Canine facial allograft models with neuromuscular motor units were performed to evaluate nerve regeneration after allotransplantation. We observed that canine facial allografts could be preserved in UW solution for at least 18 hours. Superficial temporal artery and facial artery bipedicle flaps were safer and saved more time than single pedicle flaps from the external carotid artery. Facial neuromuscular activities were shown in the canine model by the blinking reflex.

The design and technique of one stage treatment of eyelid divided nevus with island skin flap

To investigate the design and technique of the one stage treatment of eyelid divided nevus with adjacent and distant island skin flap. Under local or general anesthesia, the divided nevus on the upper and lower eyelid were excised totally or partially. According to the location, shape and size of the defect, orbicularis oculi musculocutaneous flap, postauricular SMAS-pedicled flap or reversal superficial temporal artery flap was chosen to repair the defect in one stage. The donor site was closed directly. Since 2003, 16 patients were treated in this group, with 10 orbicularis oculi musculocutaneous flaps, 3 postauricular SMAS-pedicled flaps, and 3 reversal superficial temporal artery flaps. The largest size of the nevus on the upper and lower eyelid were 2.5 cm x 2.0 cm and 4.0 cm x 3.0 cm, respectively. One postauricular SMAS-pedicled flap and 1 reversal superficial temporal artery flap showed distal venous refluence obstruction and epidermal necrosis in early postoperative stage, which healed through dressing. The other flaps survived completely. Treating eyelid divided defects with adjacent or distant island skin flap is a suitable method with satisfactory result and less morbidity in donor sites.