Temporoparietal Fascial Flap Research Articles

Amputation and Immediate Total Ear Reconstruction for a Large Arteriovenous Malformation

Summary: Due to the relative paucity of cases, there are no well-founded protocols for the management of large auricular arteriovenous malformations (AVMs) that are based on a significant number of cases. Recommendations in the literature generally separate resection of the malformation from a later reconstruction of the ear to allow for a period of disease-free status to minimize the risk of recurrence. This interval between resection and reconstruction can be cosmetically challenging for working adult patients. As auricular AVMs are often localized to the external ear, amputation is likely curative, and reconstruction should be considered at the time of resection. We present an adult male patient with a markedly enlarged left external ear secondary to a congenital AVM. The AVM was managed by auricular amputation without prior embolization. Immediate ear reconstruction was then performed using a porous polyethylene implant covered with an ipsilateral temporoparietal fascia flap. The flap was supplied by the superficial temporal artery. After 3 years, the patient has a cosmetically acceptable ear, with no signs of recurrence of the vascular malformation.

The Role and Versatility of the Temporoparietal Fascia Flap for Coverage of Cochlear Implant Extrusion.

The use of cochlear implants (CI) may be associated with different complications, being extrusion of the device one of the most common. Reconstruction of the defect with a healthy and vascularized tissue is often required. We present two patients with a CI extrusion treated with a temporoparietal fascia flap.

Temporoparietal Fascia Flap for Complex Eyelid Reconstruction: A Case Series and Literature Review

Purpose: Large, complex eyelid defects involving all layers of the upper and/or lower eyelids still present a challenging problem. Temporoparietal fascia (TPF) flap can be used in some of these cases for reconstruction. The authors review the etiology, presentation, surgical technique, and results of this procedure and review the literature to date. Recommendations are made for optimizing surgical technique and guidelines for when to use the flap. Methods: The authors present a series of 4 cases of large eyelid defects reconstructed using the TPF flap. The etiology of these defects were: congenital, trauma, tumor and complication of maxillofacial surgery. Outcomes reviewed include functional and cosmetic results, and complications. Literature review of eyelid reconstruction using TPF flap is performed. Results: All patients achieved an acceptable cosmetic and functional outcome. There was resolution of both lagophthalmos and severe exposure keratopathy in all patients. Post-operative complication occurred in one patient and involved necrosis of the skin graft over the TPF flap. This was managed with a second skin graft several weeks later with satisfactory results. Conclusion: Trauma, tumors, congenital craniofacial anomalies and maxillofacial surgery for resection of sinus tumors can cause large eyelid defects. Small eyelid defects can be repaired with lid sharing procedures but for exceptionally large defects, these techniques become insufficient. TPF flap is an excellent option and can be used in these cases to achieve an acceptable cosmetic and functional outcome with preservation of the globe. TPF flap is a versatile option which can reconstruct a large eyelid defect with one procedure. Complications can be avoided with meticulous attention to detail. TPF flap is best suited for upper and/or lower eyelid defects which are categorized as Type III or Type IV.

How I do it: epidural transposition of the temporoparietal fascia flap for anterior skull base reconstruction.

Multilayer closures and the use of vascularized flaps have been showed to be very effective in the reconstruction of the anterior skull base (ASB) after extended endonasal approaches resulting in large bone and dural defects. In the case of unavailability of a local flap, regional ones like the temporoparietal fascia flap (TPFF), used until now via a transpterygoïd route (Bolzoni Villaret et al. in Eur Arch Otorhinolaryngol 270(4):1473-1479, 2023; Fortes et al. in Laryngoscope 117(6):970-976, 2017; Veyrat et al. in Acta Neurochir (Wien) 158(12):2291-2294, 2016), can be an effective alternative. We describe a step-by-step technique of TPFF transposition via an epidural supraorbital corridor for the reconstruction of a large midline ASB defect. TPFF is a promising alternative for the reconstruction of the ASB defects.

59. A Multidisciplinary Approach to Combined Direct and Indirect Cerebral Revascularization Utilizing the Temporoparietal Fascia Flap

59. A Multidisciplinary Approach to Combined Direct and Indirect Cerebral Revascularization Utilizing the Temporoparietal Fascia Flap

Descriptive Anatomical Variant of The Superficial Temporal Artery in Temporoparietal Fascia Flap in Microtia Reconstruction

Introduction: Single-stage microtia auricular reconstruction is becoming more relevant. The determining factor is a temporoparietal fascia flap (TPF) with both branches of the superficial temporal artery (STA). There are not many studies regarding vascular branching and their relation with the frontal branch of the facial nerve, hence our study Materials and Methods: Anatomical study on TPF flap harvested during single-stage endoscopic assisted microtia auricular reconstruction from May 2018 to July 2021. Flaps were observed under microscope. Variables (vascular size, number of frontal/parietal branches, distance from branching location to estimated external ear canal, distance from frontal artery to projected course of facial nerve’s frontal branch etc.) and demographic information were obtained Results: Fifty-five flaps from 54 patients were included into the study. 50/55 (90,9%) had parietal branch and 55/55 (100%) had frontal branch with mean diameter of 0.98 and 0.91 mm respectively. Regarding frontal branch, 1.8%, 25.5%, 50.9%, 16.35, 5.45% had 0-4 traverse frontal branch(es), respectively. The mean distance from the frontal artery to the estimated course of the facial nerve’s frontal branch was 10.56 mm. 5/16 flaps that missing or small parietal/frontal branch (<0.5mm) had small necrosis while only 2/39 remaining flaps do, which is statically significant (p=0.018). All said necrosis were successfully repair with local flap, and no framework was removed. One case had nerve damage during flap harvest Conclusion: Detail anatomical description of the STA allow arterial-based flap designing and harvest, which in turn tremendously improve surgical success rate by diminishing flap necrosis and nerve damages.

Management of Oral Sub Mucous Fibrosis Using Three Different Flaps: Superficial Temporal, Nasolabial Flap, Buccal Fat Pad Flap Along with Active Physiotherapy- A Comparative Study.

To assess the efficacy of different flaps along with active physiotherapy for comprehensive management of OSMF. A total of 33 patients of oral submucous fibrosis were admitted and surgically treated. All patients were diagnosed with bilateral oral submucous fibrosis of buccal mucosa. All the patients had advanced oral sub mucous fibrosis with interincisal distance less than 20mm. Eleven patients were treated with buccal pad of fat, eleven with nasolabial flap and eleven patients were treated with temporo-parietal fascia flap. Physiotherapy was started from the 5th postoperative day and the patients were followed regularly for one year to measure maximum interincisal distance. There was a significant corelation between post-operative mouth opening and regular physiotherapy, exercise and quitting of the habit irrespective of type of reconstruction flap used. On the basis of the result obtained from this study, significant improvement in mouth opening was seen in patients who performed aggressive physiotherapy irrespective of the flap used. Thus we conclude along with the surgical treatment, post-operative physiotherapy and cessation of habit are of equal importance for good prognosis in OSMF patients.

A Case of Skin Lesion Due to Methotrexate-Related Lymphoproliferative Disorder Which Is Reconstructed by Free Temporoparietal Fascial Flap

A Case of Skin Lesion Due to Methotrexate-Related Lymphoproliferative Disorder Which Is Reconstructed by Free Temporoparietal Fascial Flap

Endonasal skull base repair with a vascularised pedicled temporo-parietal myo-fascial flap.

Expanded endonasal approaches (EEAs) to the skull base have increased the scope and extent of pathologies that can be treated endoscopically. The trade-off is creation of large skull base bone defects requiring reconstruction to re-establish barriers between the sino-nasal mucosa and subarachnoid space to prevent CSF leak and infection. A popular reconstructive technique is the local vascularized pedicled naso-septal flap, an option that may not always be possible when there is disruption of the vascular pedicle from multiple previous surgeries, adjuvant radiotherapy or extensive tumor infiltration. An alternative is the regional temporo-parietal fascial flap (TPFF) transposed via the trans-pterygoid route. We implemented a modification of this technique incorporating contralateral temporalis muscle at the tip of this flap and deeper vascularised pericranial layers within the pedicle to provide a more robust flap in selected cases. A retrospective review of two cases is presented with both patients having undergone multiple EEAs to resect skull base tumors with adjuvant radiotherapy, their postoperative courses complicated by recalcitrant CSF leaks resistant to multiple surgeries. Our patients had their persistent CSF fistulae repaired using infra-temporal transposition of the TPFF modified to include some of the contralateral temporalis muscle with optimisation of a vascular pedicle: a temporo-parietal temporalis myo-fascial flap (TPTMFF). Both CSF leaks resolved without further complication. In situations where local flap repair to reconstruct skull-base defects following EEA may not be viable or has failed, a modified regional flap incorporating temporo-parietal fascia with a preserved vascular pedicle along with attached temporalis muscle plug may provide a robust alternative option.

Posttraumatic single-stage ear reconstruction with a contralateral temporoparietal free flap: a case report

In addition to the inherent difficulties of ear reconstruction, including its three-dimensional, symmetrical, and bilateral nature, posttraumatic ear reconstruction is even more challenging because of the destruction of the adjacent soft tissues and vessels following trauma. In severe cases, ipsilateral reconstruction becomes especially difficult. In the case herein, we present posttraumatic single-stage ear reconstruction with a contralateral temporoparietal fascial free flap using a branch of a facial artery as the recipient vessel. Posttraumatic ear reconstruction should be performed after considering the extent of tissue damage, the available treatment options, and the patient’s preferences. In challenging posttraumatic ear reconstruction cases that involve a lack of soft tissue and vessels on the ipsilateral side, a contralateral temporoparietal fascial free flap using a facial artery as the recipient vessel should be considered as a treatment option.

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.

Optimizing Flap Harvest in Auricular Reconstruction.

The temporoparietal fascial (TPF) and occipital cranial fascial (OCP) flaps are the mainstay of implant coverage in alloplastic auricular reconstruction. Their optimal design is critical for elevating a robust flap that ultimately leads to favorable outcomes. Sixteen TPF and OCP dissections were performed on 8 cadaveric specimens. Vascular anatomy and key landmarks were documented. The minimum flap size that incorporated ideal vasculature and would appropriately cover a porous polyethylene implant was measured. The minimum flap dimensions (length × width × base width) to cover a standard PPE auricular implants were on average 11×8.3×6.4cm for TPF and 13.1×8.6×6.5cm for OCP. The average axial length of the superficial temporal artery and occipital artery were 12.51 and 13.2cm, respectively. An "occipital elbow" was located on average 8.2cm posterior to the external acoustic canal. The postauricular fascia contained additional contributions from the occipital artery and mastoid emissary vein, which was located on average 5.9cm posterior to the superficial temporal artery. This study highlights the anatomic features behind optimal TPF and OCP flap design for auricular reconstruction. Contributions to axial length and anatomic relationships of their primary arterial supply, significance of the occipital elbow as a reliable landmark for fascial dissection, and importance of the postauricular fascia and its vascular supply for flap viability are emphasized. Ultimately, the authors provide minimal dimensions for both TPF and OCP flaps to obtain adequate alloplastic implant coverage.

Surgical Outcomes of Using Temporoparietal Fasciocutaneus and Temporoparietal Pedicle Flap for Auricular Reconstruction.

Background:Temporoparietal fasciocutaneus and temporoparietal fascial pedicle flaps play an important role among many techniques for auricular reconstruction. Because of their unique characteristics, the flaps based on the superficial temporal artery may be used for various types of reconstruction.Methods:In this article, we present several applications of the temporoparietal fasciocutaneus and temporoparietal fascial pedicle flaps in the reconstruction of defects after ear resection, including the use of the sandwich flap.Results:Our experiences presented in this case series confirm the reconstructive potential of the flaps, also in patients in whom the Vistafix® system was used for reconstruction of the ear.Conclusions:In all cases described herein, the use of the pedicle flaps resulted in optimal healing and satisfactory cosmetic and functional outcomes.

Single-incision endoscopic-assisted temporoparietal fascia harvest for single stage auricular reconstruction.

The temporoparietal fascia flaps (TPFF) have been widely used to cover the framework in auricular reconstructions. However, flap harvesting is mostly done by open surgery which may be easier but often results in bad scarring and hair loss. We would like to present aseries of cases using endoscopic-assisted flap harvesting techniques with only one single cosmetic auricular incision. Prospective studies from June 2018 to September 2021 on patients who underwent single-stage total auricular reconstruction using autologous costal cartilage and porous polyethylene (PPE) framework. Variables include age, gender, flap survivability as well as visual results and complications. Atotal of 61 TPFFs were harvested to cover 15 autologous costal cartilages and 46 PPE frameworks in 60 patients (one patient had operation on both sides). TPFF harvests are performed by endoscopic techniques with one single auricular incision. There was no flap necrosis, no bleeding and no cases required framework removal. Only 7/61 (11.5%) ears had small framework exposure which resolved on their own or only required local skin flap coverage and 1 ear had frontal nerve injury. Single-stage auricular reconstruction is adifficult surgery, yet greatly beneficial to young children. Through asingle-incision endoscopic technique, we can obtain sufficiently large high-survivability TPFFs ensuring full coverage of the autologous costal cartilage or PPE framework. This method is reliable, and reproducible with advanced training. After reviewing the literature, we can state that our report probably includes the largest endoscopic-assisted TPFF harvesting series and the first to implement single-incision endoscopic technique in auricular reconstructions.

Two Case Reports: Reconstruction of Heat Press Injury of the Hand Using a Free Temporoparietal Fascial Flap Followed by Scar Contracture Repairing

Two Case Reports: Reconstruction of Heat Press Injury of the Hand Using a Free Temporoparietal Fascial Flap Followed by Scar Contracture Repairing

Temporoparietal Fascial Free Flap: A Systematic Review.

The temporoparietal fascial flap (TPFF) is a versatile tool used in head and neck reconstructive surgeries as well as distal upper and lower extremity reconstructions. Depending on the anatomical location and characteristics of the recipient site soft tissue defects, harvesting techniques for TPFF retrieval may include elevation as a pedicle or a free flap, inclusion of the temporalis muscle and/or adjacent calvarial bone as a composite flap. The TPFF as a free flap is not only used for soft tissue coverage of various defects, and it can be used as a joint gliding surface with coverage of nerve and tendons after repair or trauma. This article includes a systematic search of the medical literature for indications, historical background, techniques, current perspective, and complications along with the pros and cons of the free TPFF compared with other potential reconstructive options.

A large invasive chondroblastoma on the temporomandibular joint and external auditory canal: a case report and literature review

BackgroundChondroblastomas, which account for approximately 1% of all bone tumors, typically occur in long bones, such as the femur, humerus, and tibia. However, in extremely rare cases, they may also occur in the craniofacial region where the tumor is often found in the squamous portion of the temporomandibular joint (TMJ) and in the temporal bone.Case presentationThis case report describes a large chondroblastoma (diameter, approximately 37 mm) that occurred in the TMJ. The tumor was sufficiently aggressive to destroy the TMJ, mandibular condyle neck, external auditory canal (EAC), mandibular fossa of the temporal bone, and facial nerve. The tumor was completely excised using a pre-auricular approach. The EAC and surgical defect were successfully reconstructed using a temporoparietal fascia flap (TPFF) and an inguinal free fat graft. There was no local tumor recurrence at the 18-month follow-up visits. However, the patient developed sensory neural hearing loss, and his eyebrow paralysis worsened, eventually requiring plastic surgery.ConclusionLarge, invasive chondroblastomas of the TMJ can be completely removed through a pre-auricular approach, and the resulting surgical defect can be reconstructed using TPFF and free fat grafts. However, preoperative evaluation of the facial nerve and auditory function is necessary. Therefore, a multidisciplinary approach is essential.

Outcome of Auricular Reconstruction with Porous Polyethylene Frameworks: Our 10 Years of Experience with 113 Children and Adults.

This study evaluates the surgical outcome and patient benefit after auricular reconstruction with porous polyethylene frameworks and temporoparietal fascia flaps in both children and adults. A total of 161 patients who had undergone auricular reconstruction between 2003 and 2014 by doctors in our department were asked to answer both a validated health-related quality-of-life questionnaire (Glasgow Benefit Inventory or Glasgow Children's Benefit Inventory) and a questionnaire reporting satisfaction, complaints, and complications with the reconstructed pinna. Furthermore, postoperative surgical complications were recorded. A total of 113 patients (89 individuals older than 14 and 24 children under the age of 14) returned the questionnaires. About 80% of the patients were satisfied with the results of their auricular reconstruction. The main complaints concerned scars and the shape. Patients' quality of life was correlated with their postoperative aesthetic satisfaction. Thus, framework extrusion was the principal factor affecting patients' satisfaction, whereas treatable postoperative complications did not interfere with the overall quality of life. Interestingly, children indicated greater benefit from auricular reconstruction than older patients. With regard to the patient's feeling of being physically healthy after auricular reconstruction, partial pinna reconstruction and reconstruction without simultaneous hearing restoration should be very carefully considered. Auricular reconstruction using a porous polyethylene framework significantly increases the patients' health-related quality of life and leads to significant patient satisfaction, especially in the case of younger patients.

The Infratemporal Retro-Eustachian Transposition of the Temporoparietal Fascial Flap for Clival Reconstruction After Endoscopic Endonasal Approach: An Anatomic Conceptual Technique.

Reconstruction after endoscopic endonasal approaches is a key element. Lower clivus reconstruction is difficult and most of the times a pedicled flap is not available. As the complexity and the dimensions of the exposure increase, a reliable reconstruction technique becomes more and more important. To describe the anatomic and technical nuances of the transposition of the temporoparietal fascial flap for lower clivus reconstruction. A specific temporoparietal fascial flap (TPFF) design and tunneling technique has been studied using 4 head specimens, microscopic and endoscopic surgical techniques, and neuronavigation. The L-shaped flap offers several advantages. It can be tunneled directly toward the lower clivus passing through the infratemporal fossa. The infratemporal retro-eustachian transposition of an L-shaped TPFF provides a vascularized tissue virtually without dimension limits. This is the only technique that allows the flap to be tunneled directly in the lower clivus with the most vascular portion being at the bottom of the defect. Clinical validation is still required since more issues may become relevant in a real-surgery setting. Though, due to its possible complications, this methodology needs further testing and should not be attempted in less experienced hands.

Temporoparietal Fascia Flaps in Children Under 15 Years of Age: An Anatomic Investigation and Its Clinical Implications in Auricular Reconstruction.

Background:The temporoparietal fascia (TPF) flap has been successfully used in the treatment of microtia with primary or secondary cases. The literature contains numerous studies about its structure and vascular anatomy in adults. However, it is rare to study its vasculature and characteristics in children.Methods:From September of 2013 to May of 2020, 188 patients with average age of 9.8 years (range, 5–14 years) underwent total ear reconstruction with costal cartilage in 67 patients (68 ears) or porous polyethylene framework in 121 patients (128 ears) using 196 TPF flaps. The TPF flap was most commonly used in second-stage operations to elevate the reconstructed auricle in the costal cartilage group. Contrastingly, the TPF flap was routinely used in the porous polyethylene framework group. The vascular pattern and characteristics of the TPF flap were evaluated during flap elevation.Results:Only 140/196 cases (71.4%) showed a typical pattern with the superficial temporal artery and the superficial temporal vein in this study; others (28.6%) were supplied by combinations of the posterior auricular artery or vein, occipital vein, diploic vein, and superficial artery or vein. Meanwhile, there are variants of the STA and posterior origin-superficial temporal artery, which originates posterior to the lobule beneath the cartilage remnant (3/196, 1.5%).Conclusion:Surgeons should inspect the pattern of the TPF flap thoroughly before elevation in children, because of the variety of the vessels and anatomic patterns of TPF.