Superficial Temporal Fascia Flap Research Articles

Revision Operation of the Unsatisfactory Microtia Reconstruction With Autologous Costal Cartilage.

Revision operation of the unsatisfactory microtia reconstruction is 1 of the most difficult revision operations in plastic surgery. This study discussed the cases about revision operation of the unsatisfactory or failed ear reconstruction using autologous costal cartilage and residual. A prospectively maintained database of all consecutive patients who underwent secondary total ear reconstruction from 2013 to 2020 was reviewed. Demographic data and outcomes were assessed. Thirty-six patients with microtia met the inclusion criteria. The age of the patients who underwent secondary reconstruction ranged 6 to 56 years. The follow-up duration was from 1 to 8 years. Primary reconstruction using costal cartilage was performed in 34 cases, and Medpor (porous high-density polyethylene) were used in 2 cases. All 36 cases were treated with costal cartilage as the revision. One-stage revision was performed in 27 cases, including scaffold covered by superficial temporal fascia flap in 9 cases, retroauricular fascia flap in 12 cases and superficial temporal plus retroauricular fascia flap in 5 cases. Nine cases were renovated with expanders by stages, of which 8 cases were covered by retroauricular fascia and 1 case was covered by expanded skin flap. Complications occurred in 2 cases, and 1 patient was not satisfied with the partial scaffold repair. The effect of revision operation of ear reconstruction with costal cartilage is satisfactory, and different methods of ear reconstruction are indicated in different operation conditions, and the revision surgery requires adequate preoperative evaluation.Level of Evidence: Level IV, therapeutic study.

Classification and Surgical Strategies of Constricted Ears in a Chinese Specialty Clinic: A Retrospective Study.

BackgroundThe constricted ear is an auricular deformity produced by a deficiency in the circumference of the helical rim. The classification and corrective methods for constricted ears continue to be controversial. In order to identify them, the authors have reviewed and analyzed cases operated in a Chinese specialty clinic.MethodsCorrection of constricted ears from January of 2017 to June of 2021 was retrospect through medical records. Data of patients’ variables (including sex, age, laterality, type of constricted ear, presence of other ear anomalies), surgical techniques, esthetic outcomes, and postoperative complications have been collected.ResultsThe deformed ears were classified into four graded types by three criteria including deficiency of auricle cartilage, vertical height in dorsal view, and surgical outcome. A total of 68 constricted ears of 57 patients (type I, n = 6; type IIA, n = 41; type IIB, n = 19, and type III, n = 2) were enrolled in the study. Of the 66 constricted ears undergoing surgical correction, most of them were performed with helical expansion through auricular/costal cartilage graft, Mustardé-type mattress sutures, and tumbling cartilage flap. External molding using Vaseline gauze rolls was implemented on every case to assist reshaping the scapha. A triangular superficial temporal fascial flap was elevated to prevent the reoccurrence of lidding in some cases. Corrective techniques and esthetic outcomes for deformed cases of each graded type were described. Based on a four-point Likert scale, the average esthetic outcome score was 3.7.ConclusionsThe classification was practical and the constricted ears were effectively corrected by simple surgical procedures without removal of deformed auricular cartilage. All corrections were performed in one stage.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Correction of microtia with constriction features using a superficial temporal fascial flap combined with a rib cartilage graft.

BackgroundMicrotia with constricted features is characterized by a short helical length of variable severity, upper antihelical or scaphal deficiency, and a downfolded upper ear. No consensus has been reached regarding the most appropriate surgical method for this condition. In this study, we aimed to introduce a simple and safe surgical method for the correction or reconstruction of upper helix ear deformities.MethodsBetween February 2011 and June 2014, eight patients with microtia with constricted upper helix ear deformity underwent reconstruction of the ear deformity. The upper ear helical framework was constructed by carving and curving the eighth rib cartilage harvested from the ipsilateral chest wall, covering this cartilage with a superficial temporal fascial flap, and adjusting the skin graft to align with the ear contour. To evaluate their satisfaction, patients were asked to complete a questionnaire regarding ear shape, symmetry, position, color, and overall outcome scored on a 5-point scale at 12 months postoperatively.ResultsNone of the patients experienced severe complications in the reconstructed ear. The preoperative and postoperative vertical ear length ratios were 0.88 and 1.02, respectively. And the mean patient satisfaction scores for shape, symmetry, position, color, and overall outcome were 4.2, 4.5, 4.7, 4.4, and 4.6 out of 5 points, respectively. All patients expressed a high level of satisfaction at 12 months postoperatively.ConclusionsOur technique provides a good alternative method for the reconstruction of moderate constricted upper helix ear deformities in patients who meet the surgical indications with satisfactory outcomes and few complications.

Clinical application effects of portable visual retractor in superficial temporal fascia flap harvesting

Objective: To explore the clinical application effects of portable visual retractor in superficial temporal fascia flap harvesting. Methods: From January 2010 to June 2019, 27 patients meeting the inclusion criteria and planning to perform operation of superficial temporal fascia flap harvesting were admitted to the Department of Plastic and Reconstructive Surgery of the First Clinical Medical Center of the People's Liberation Army General Hospital. The patients were divided into traditional surgical method group [6 males and 3 females, aged (34±14) years], cold light source retractor group [6 males and 4 females, aged (35±16) years], and portable visual retractor group [7 males and 1 female, aged (30±14) years] according to way of superficial temporal fascia flap harvesting. The superficial temporal fascia flaps of patients in traditional surgical method group were resected by traditional way of resection, and the superficial temporal fascia flaps of patients in cold light source retractor group and portable visual retractor group were resected at assistance of cold light source retractor and portable visual retractor, respectively. Length of incision, operation time, intraoperative blood loss volume, postoperative drainage volume, and postoperative complication of patients in 3 groups were observed and recorded. Data were processed with Fisher's exact probability test, one-way analysis of variance, least significant difference test, Kruskal-Wallis H test, and Bonferroni correction. Results: The length of incision of patients in visual retractor group was (3.6±0.8) cm, significantly shorter than (12.6±1.6) cm in traditional surgical method group and (5.8±0.9) cm in cold light source retractor group (P<0.05). The incision length of patients in traditional surgical method group was significantly longer than that in cold light source retractor group (P<0.05). The operation time of patients in visual retractor group was 24.0 (23.3, 25.8) min, significantly shorter than 35.0 (30.5, 36.5) min in traditional surgical method group and 28.5 (26.8, 30.5) min in cold light source retractor group (H=16.5, 9.8, P<0.05). The operation time of patients in traditional surgical method group was significantly longer than that in cold light source retractor group (H=6.6, P<0.05). The intraoperative blood loss volume was (26±3) mL of patients in visual retractor group, significantly less than (34±4) mL in traditional surgical method group and (30±6) mL in cold light source retractor group (P<0.05). The intraoperative blood loss volume of patients in traditional surgical method group was significantly more than that in cold light source retractor group (P<0.05). The postoperative drainage volumes of patients in visual retractor group, cold light source retractor group, and traditional surgical method group were (33±4), (34±6), and (31±7) mL, respectively, and there were no significantly statistical differences in postoperative drainage volumes among patients in the three groups (F=0.3, P>0.05). There were no severe complications such as ischemia and necrosis of superficial temporal fascia flaps in patients of the three groups. One patient in cold light source retractor group had subcutaneous hematoma after operation, which was improved by removing stitches and hematoma. Conclusions: Superficial temporal fascia flap harvesting at the assistance of portable visual retractor has the advantages of clear visual field, simple operation, short operation time, small incision, and less intraoperative blood loss.

Experience of Raising Flaps Using Cadavers Embalmed by Saturated Salt Solution Method

Sir: In plastic and reconstructive surgery, raising the flap is an important skill1; but sometimes it is difficult for young plastic surgeons to detect and isolate the vessels. However, only a few studies have focused on flap training using cadavers. In these studies, researchers used formalin fixation techniques, which produced tissues with rigidities too high to provide a realistic simulation of flap training.2 Therefore, preservation methods such as fresh cadaver3,4 and Thiel method2 have been favored. Fresh cadaveric tissue is a superior model of simulation because of its approximation of live tissue,4 but it has many disadvantages such as high cost, limited use, and risk of infection.1,2 Thiel-embalmed cadavers have life-like color and flexibility.2 However, Thiel method is quite complicated and requires the use of several problematic and expensive substances during its preservation process. In addition, Thiel-embalmed cadavers have their drawbacks: muscular disintegration and limited time for dissection.5 Recently, Hayashi et al5 reported that the cadavers embalmed by the saturated salt solution (SSS) method, which consisted of saturated sodium chloride, low-dose formaldehyde, phenol, glycerin, isopropyl alcohol, and water, were not less suitable than Thiel-embalmed cadavers in several skills training courses in acute care surgery. Therefore, the authors tried raising several flaps in the SSS-cadavers for future use in flap training. Four SSS-embalmed cadavers and 1 Thiel-embalmed cadaver were used for this study, and the procedures were performed in an anatomical training room at Tokyo Medical University. All procedures were performed by Takayuki Shirai (a plastic surgeon with 9 years of experience). The cadavers were used 1–6 months after they had been preserved, and each cadaver was used several times. The types of flaps made included the following: oblique triangular flap, reverse digital artery island flap (Fig. 1), latissimus dorsi musculocutaneous flap, superficial temporal fascia flap, nasolabial flap, and anterolateral thigh flap (Fig. 2).Fig. 1: Reverse digital artery island flap.Fig. 2: Anterolateral thigh flap.Because SSS-embalmed cadavers tend to have realistic skin and soft tissue, anatomical structures were easy to identify and the operations could be performed very much as in live patients (Figs. 1, 2). These features of SSS-embalmed cadavers were almost identical to those in Thiel-embalmed cadavers. In addition, the vessels of the SSS-embalmed cadavers were more expanded because of ample fluid, making our detection and isolation of vessels and raising of flaps easier in them than in the Thiel-embalmed cadaver. CONCLUSIONS SSS-embalmed cadavers are sufficiently useful in flap training. The SSS method is simple with a low infection risk and relatively low cost.5 Furthermore, SSS-embalmed cadavers have availability for multiple uses and their vessels can be easily detected. Our trial suggests that the characteristics of SSS-embalmed cadaver may be ideal for trainees of plastic surgery. ACKNOWLEDGMENTS We thank Dr. Ning Qu, Dr. Naoyuki Hatayama, and Dr. Shuichi Hirai for reviewing and providing useful comments to us preparing in our manuscript. We also thank Mr. Shinichi Kawata and Mr. Koichi Koyama for their excellent technical assistance, and Ms. Yuki Ogawa, Ms. Miyuki Kuramasu, and Ms. Keiko Kuwana for their excellent secretarial assistance. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. This study was supported by JSPS KAKENHI Grant Number 26463257. The Article Processing Charge was paid for by the authors. Takayuki Shirai, MD Department of Plastic Surgery Asama General Hospital Saku-shi, Nagano, Japan Department of Anatomy Tokyo Medical University Shinjuku-ku, Tokyo, Japan Shogo Hayashi, MD, PhD Masahiro Itoh, MD, PhD Department of Anatomy Tokyo Medical University Shinjuku-ku, Tokyo, Japan

Turnover Superficial Temporal Fascia Flap: A Galeopericranial-Based Random Flap for Coverage of Vertex Defects on the Scalp

Turnover Superficial Temporal Fascia Flap: A Galeopericranial-Based Random Flap for Coverage of Vertex Defects on the Scalp

Prefabricated Neck Expanded Skin Flap with the Superficial Temporal Vessels for Facial Resurfacing

The achievement of a normal-appearing face after surgical resurfacing remains an elusive goal. This is due in part to insufficient color matching, restoration of contours, and the persistence of visible scars. Flap prefabrication is a staged procedure that provides an independent axial blood supply to local expanded tissues. We describe a new reconstructive alternative with superior reconstructive surgical options for facial resurfacing that better matches damaged or discarded facial tissues. A superficial temporal fascial flap was harvested as the vascular supply of the prefabricated neck flap and located in a subcutaneous neck pocket over a tissue expander. After a 5-month period for expansion and maturation, the prefabricated skin flap was raised, islanded, and rotated to resurface the facial defect. Four patients with hemifacial postburn contracture and two patients affected by hemifacial vascular malformations aged 17 to 42 years (mean 29 years) were successfully treated with no major complication after a mean period of 15 months. Prefabricated neck-expanded skin flap demonstrated an excellent color and texture match with facial skin that surrounded the repair sites, and optimal aesthetic results were obtained. Importantly, facial expression was completely maintained due to thinness and pliability of the rotated skin.

A new procedure to correct the crow's feet by covering the orbicularis oculi muscles with the superficial temporal fascia flap in rhytidectomy

To explore an ideal procedure with more lasting aesthetic results by covering the orbicularis oculi muscles with the superficial temporal fascia flap in rhytidectomy, which can help to correct the crow's feet successfully. During rhytidectomy, dissection was performed subcutaneously and also under pericranium and superficial temporal fascia at temporal area. Then the superficial temporal fascia flap was formed by cutting between pericranium and superficial temporal fascia. The fascia flap was reversed to cover the lateral orbicularis oculi muscle with fixation. From May 2004 to May 2010, 18 cases were treated with a follow-up period of 6-12 months. The crow's feet was corrected better with long lasting results, compared with conventional rhytidectomy. No complication happened. The crow's feet can be corrected markedly with long lasting results by covering the orbicularis oculi muscles with the superficial temporal fascia flap in rhytidectomy.

Total lower eyelid reconstruction with superficial temporal fascia flap and porous polyethylene implant: A case report

Total reconstruction of the eyelid after serious periorbital injury is a challenging procedure for plastic and reconstructive surgery. Although several methods have been used for reconstructing the eyelids, such as advancement flap with fascia lata sling, island mucochrondrocutaneous flap, prefabricated temporal island flap, porous polyethylene and superficial temporal fascia flap, creating a supportive eyelid for housing an artificial eye without complication is still an ongoing problem. In the case presented, superficial temporal fascia flap with porous polyethylene was used for the reconstruction of total lower eyelid.

Superficial Temporal Fascial Flap Plus Lipofilling for Facial Contour Reconstruction in Bilateral Progressive Facial Hemiatrophy

Progressive facial hemiatrophy (PFH) was first described by Parry in 1825 and later by Romberg in 1846 and was also known as Parry-Romberg syndrome. Progressive facial hemiatrophy, as the name suggests, usually has unilateral presentation. However, bilateral manifestation has been reported in 5-10% of the cases. It is a rare disorder with few cases reported. Treatment involves augmentation of the atrophic region and restoration of symmetry of the face. Because many tissues are needed, it is very difficult to treat. In this article we report the use of a superficial temporal fascial flap plus lipofilling to treat bilateral progressive facial hemiatrophy. We obtained good facial volume, smooth contour, and soft palpation. It is safer, simple to perform, and more cost effective than free tissue transfer. It is a suitable technique of choice in the treatment of bilateral progressive facial hemiatrophy.

A New Design for Superficial Temporal Fascial Flap for Reconstruction of the Eyebrow, Upper and Lower Eyelids, and Lacrimal System in One-Stage Procedure

Reconstruction of the eyebrows, eyelids, and destroyed lacrimal drainage system is a challenging procedure for plastic and reconstructive surgeons. In the case presented, a superficial temporal fascial flap was designed for reconstruction of the eyebrow, upper and lower eyelids, and lacrimal drainage system in a one-stage procedure in facial burn patient. To the authors' knowledge, this is the first combined reconstruction of the eyebrow, upper and lower eyelids, and lacrimal drainage system in one surgical procedure with pedicled superficial temporal fascial flap including skin island and buccal mucosal graft. During the 1-year follow-up period, no complication was encountered and patient healed uneventfully.

Surgical Treatment of an Exposed Orbital Implant With Vascularized Superficial Temporal Fascia Flap

Orbital implants are often used for the correction of volume deficit after enucleation or evisceration. An orbital implant enhances aesthetics and improves mobility of the subsequent prosthetic eye. With advancements in technology and techniques, implant-related complication rates have been decreased. However, implant exposition as one of the most common complications of socket surgery is still a problem for the oculoplastic surgeon. Many factors are thought to cause orbital implant exposure: Large implants, tension on the wound, and textured surface of the implant may cause a breakdown of the covering layers over the implant. Inadequate fibrovascular ingrowth into the porous implant is the most important factor. Various surgical methods have been described to cover the defect, most offering the use of various tissues as a graft, which are not always satisfactory. We describe a case with silicone implant exposition that was managed with a vascularized superficial temporal fascia flap. According to our knowledge, this is the first article reporting the usage of a vascular tissue in the management of an orbital implant exposure.

Uses of the Superficial Temporal Fascial Flap in Facial Paralysis

The superficial temporal fascia merits its popularity in reconstructive surgery for its large number of clinical applications. In this report, the authors present their experience with different uses of the superficial temporal fascial flap in facial reanimation. Seventeen cases are presented. In 10 patients, the fascial flap provided a vascularized lining at the interface between the free muscle flap for smile restoration and the overlying skin. In six cases, it was utilized to correct small or moderate contour deficits in the paretic hemiface, using either the fascial flap alone or in combination with free adipose tissue. One patient presented with facial paralysis and Frey syndrome following parotidectomy, and the fascial flap was used to control gustatory sweating. Five independent observers graded aesthetic and functional outcomes on a scale from poor to excellent. Three patients were lost to follow-up, so 14 cases were evaluated. Follow-up ranged from 1 to 216 months (47 +/- 60.49 months). The specific reconstructive goal for each patient was achieved and the overall symmetry was greatly improved, with all patients being granted higher scores by the panel of observers following the superficial fascia flap (Wilcoxon matched-pairs signed ranks, p < 0.0001). Transient or permanent alopecia along the temporal incision was the main complication observed. Transfer of the superficial temporal fascia flap is a valuable technique with several potential applications in facial paralysis management and reconstructive surgery in general. The advantages of this highly vascularized, gliding, and pliable flap far outweigh the associated minimal complications.

Application of superficial temporal fascia flap in reconstruction of temporal depression

目的 探索颞浅筋膜瓣在除皱术中充填颞部凹陷的效果,并进行初步评价.方法在额眶部骨膜下除皱的同时,根据颞部凹陷的程度切取相应面积的颞浅筋膜瓣翻转后充填颞部凹陷.结果经3～4年随访,该法用于颞部凹陷患者除皱的辅助治疗,不仅能获得满意的远期丰满外形,还使面部轮廓得以改善.结论采用颞浅筋膜瓣在除皱术中Ⅰ期充填颞部凹陷,能够使面部同时达到提紧及轮廓整复的目的,术后效果满意。

Release of oral submucous fibrosis and reconstruction using superficial temporal fascia flap and split skin graft—a new technique

Long standing oral submucous fibrosis is associated with involvement of the oral submucosa and the muscles of mastication leading to difficulty in mouth opening. Various surgical modalities are mentioned for release but each has its own limitations. This article introduces a new technique of release of submucous fibrosis and reconstruction using superficial temporal fascia flap and split skin graft. The surgical technique involves a pre-auricular incision extending into the temporal region with dissection carried out in the sub follicular plane to develop the superficial temporal fascia flap to its maximum extent. The masseter muscle origin is released from the zygomatic arch and the temporalis muscle insertion is released from the coronoid process through an external approach. The entire fibrosed mucosa is released intraorally to create a mucomuscular defect thus achieving full mouth opening. The superficial temporal fascia flap is then brought in and sutured to the intraoral defect, which is then covered with a split thickness skin graft. This procedure is performed bilaterally. A total of five patients were treated with this new technique and all of them showed good mouth opening in long term follow up. There was no donor site morbidity. The incision line is well hidden in the hair bearing area. A well vascularised superficial temporal fascia flap brings in good blood supply to the area of affected muscle and mucosa to improve its function.

One stage otoplasty with compound framework of Medpor and homogenous rib cartilage

目的 探寻耳廓再造的良好手术方法.方法将高密度聚乙烯耳基架与肋软骨外耳轮形成复合支架,支架采用颞浅筋膜瓣包裹,颞浅筋膜瓣的表面采用邻近皮瓣和皮片覆盖,完成耳廓再造.结果自2000年1月至2003年8月利用该方法对8例先天性小耳进行耳廓再造术效果良好.结论通过该方法行耳廓再造,具备良好的外形和一定的弹性,外观逼真,手感良好。

Free Thin Anterolateral Thigh Adipofascial Flap for Reconstruction of Hand Dorsum Defect

There are many flap choices for reconstruction of dorsal hand defect with extensor tendon exposure. Free flap, such as superficial temporal fascia flap or dorsalis pedis flap, is an optional choice because it provides thin, pliable coverage and good gliding surface for extensor tendons. The anterolateral thigh flap is an another alternative, however, thick and bulky of flap lead to unfavorable results. We modified the anterolateral thigh flap with only including adipofascial layer to reconstruct the soft tissue defect of hand dorsum. A 60 year-old of female patient suffered from metastatic Transitional Cell Carcinoma of the bladder. The extravasation of the chemotherapeutic agents led to skin necrosis over her right dorsal hand. We reconstructed the defect of her right dorsal hand by the free thin anterolateral thigh adipofascial flap. The result of the right dorsal hand was satisfactory after 3 months follow-up. The anterolateral thigh adipofascial flap provided vascularized, thin, and gliding coverage. The donor side can be closed primarily. However, it still bears the disadvantages of needing for skin graft and risk of skin graft failure due to fatty necrosis.

Prefabricated superficial temporal fascia flap combined with a submental flap in noma surgery.

The authors report their experience with a new procedure: the combination of a prefabricated superficial temporal fascia flap and a submental flap performed in an African hospital on five patients with cheek deformities caused by noma. The prefabricated superficial temporal fascia flap makes the inner lining of the cheek, which is anchored on the peripheral scar tissue. The submental flap is released during the second operation and makes the outer lining. The main advantages are the excellent aesthetic color of this last flap and the short distance between the donor site and the recipient site. Moreover, the submental flap is positioned in a single operation (when the outer-lining reconstruction is performed with a deltopectoralis flap, a third operation is necessary to cut the pedicle). None of the flaps failed, and the functional results were good. The prefabricated superficial temporal fascia flap and submental flap are versatile and reliable flaps, with reasonably long vascular pedicles, that can be used successfully, even under suboptimal conditions in weak patients with huge defects of the face.

Prefabricated Superficial Temporal Fascia Flap Combined with a Submental Flap in Noma Surgery

Barthélémy, Isabelle M.D.; Martin, Dominique M.D.; Sannajust, Jean-Philippe M.D.; Marck, Klaas M.D., Vincent Pistre, M.D.; Mondié, Jean-Michel M.D. Author Information

The prefabricated superficial temporal fascia flap in noma surgery

In a series of 15 patients with facial deformity due to noma, the authors report their experience with a prefabricated superficial temporal fascia (PTF) flap performed in an African hospital. The operative method has been simplified as compared with methods described by others. In the first stage, the temporal fascia is skin grafted and the wound is closed over the graft. After only 1 week, this prefabricated flap is harvested. One of 15 flaps was discarded because of damage to the vascular pedicle. Later this situation was prevented by including a rim of deep temporal fascia in the flap. All other 14 flaps, including four osteocutaneous flaps and one flap with double sided skin grafts, survived and healed without major complications at both the recipient and the donor site. The prefabricated temporal fascia flap is a pliable and well vascularized flap with a reasonably long vascular pedicle, which can be used successfully, even under suboptimal conditions.