Temporoparietal Fascia Research Articles

Primary Palate Reconstruction Using the Pedicled Temporoparietal Fascia Flap after GSW Injury: Improve Quality Of Life As You Save a Life

Primary Palate Reconstruction Using the Pedicled Temporoparietal Fascia Flap after GSW Injury: Improve Quality Of Life As You Save a Life

Primary Palate Reconstruction Using the Pedicled Temporoparietal Fascia Flap after GSW Injury: Improve Quality Of Life As You Save a Life

Primary Palate Reconstruction Using the Pedicled Temporoparietal Fascia Flap after GSW Injury: Improve Quality Of Life As You Save a Life

The Temporoparietal Fascia Flap is an Effective Strategy for Cochlear Implant Wound Coverage

To report the rate of major soft tissue complications after cochlear implantation and to describe the use of the temporoparietal fascia (TPF) flap for such complications. Retrospective case series. Tertiary care, University Hospital. Chart review of all patients who underwent cochlear device implantation over a 5-year period to identify patients and to determine the rate of soft tissue complications. Five patients with major soft tissue complications underwent TPF flap with device salvage or explantation/reimplantation. The rate of major skin complications was 6 out of 281 (2.1%) over 5 years, with 5 patients undergoing TPF flap. The average follow-up was 25.8 months (range, 5-58 months). TPF flap represented the definitive, successful solution for all 5 patients. One postoperative hematoma occurred after TPF flap, with no long-term sequelae. The average hospital length of stay was 2.2 nights (range, 1-5 nights). One patient required IV antibiotics for 4 weeks; the remaining patients were treated with a postoperative course of oral antibiotics. The original device remained in place for 4 patients, while one case required device explantation and staged re-implantation. Post-TPF flap hearing results were equal to if not superior to their preoperative results. Major soft tissue complications following cochlear device implantation are rare. The temporoparietal fascia flap is an excellent option for reconstruction of device site soft tissue dehiscences when local wound care and primary closure are not sufficient, and can potentially prevent explantation of a functional implant.

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

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

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

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

Outcomes of Nasal Septal Perforation Repair Using Combined Temporoparietal Fascia Graft and Polydioxanone Plate Construct.

Numerous techniques are used for septal perforation repair, yet success rates remain variable. Few studies have evaluated the effectiveness of interposition grafts of polydioxanone plates combined with a temporoparietal fascia graft for septal perforation repair. To investigate and describe the use of interposition grafts of polydioxanone plates combined with a temporoparietal fascia graft for septal perforation repair and the expansion of this technique to patients with more challenging comorbidities, including granulomatosis with polyangiitis. A retrospective medical record review was performed of patients who underwent septal perforation repair using interposition grafts of polydioxanone plates combined with a temporoparietal fascia graft from January 1, 2015, to July 1, 2018, at Vanderbilt University Medical Center and from January 1, 2017, to July 1, 2018, at the University of Iowa. All patients underwent septal perforation repair with interposition grafts of polydioxanone plates and a temporoparietal fascia graft. Assessing closure of septal perforation was the primary outcome. Secondary outcomes were resolution of presenting symptoms of septal perforation, area of perforation, length of postoperative stent and silastic sheeting placement, postoperative complications and resolution, and duration of follow-up. Preoperative and postoperative Nasal Obstruction Symptom Evaluation (NOSE) scores were assessed. A total of 17 patients (12 women and 5 men; mean [SD] age, 45 [15] years) were included. The causes of perforations were iatrogenic (9 [53%]), rheumatologic (2 [12%]), and unknown or idiopathic (6 [35%]). Patients most commonly presented with nasal crusting (12 [71%]), whistling (9 [53%]), nasal obstruction (9 [53%]), and epistaxis (5 [29%]). Mean (SD) perforation size was 0.99 (1.04) cm2. Mean (SD) postoperative follow-up was 6.1 (4.1) months. A total of 15 patients (88%) had complete resolution of presenting symptoms at last follow-up. All perforations were closed with overlying mucosa at the most recent follow-up examination. Nine of 17 patients completed both preoperative and postoperative NOSE. There was a significant difference between the mean (SD) preoperative and postoperative NOSE scores (62.78 [27.74] vs 17.78 [15.83]; P = .004). Repair of symptomatic nasal septal perforations using a temporoparietal fascia graft combined with a polydioxanone plate was associated with positive outcomes. Repair of septal perforations caused by rheumatologic disease, including granulomatosis with polyangiitis, can be considered for repair using this technique. Resolution of symptoms appeared to be clinically more meaningful in evaluation of septal perforation repair than rate of perforation closure, and the NOSE scale has the potential to serve as an objective corroboration to patient-reported postoperative outcomes. 4.

The surgical anatomy of soft tissue layers in the mastoid region.

BackgroundAn understanding of the soft tissue layers in the mastoid region has become important for otologic reconstructive surgery. The objective of this study was to clarify the surgical anatomy of the soft tissue layers in the mastoid region and reveal its clinical significance.MethodsCadaveric study.ResultsOur dissections showed the soft tissue layers consisting of skin, subcutaneous layer, superficial and deep mastoid fasciae, and periosteum. The superficial mastoid fascia was continuous with the temporoparietal fascia cranially and the superficial cervical fascia caudally. The deep mastoid fascia could be clearly separated from the superficial mastoid fascia and has continuity to the loose alveolar layer in the temporoparietal region. However, it caudally fused with the fascia and ligament of the sternocleidomastoid.ConclusionsA comprehensive understanding of soft tissue layers would improve otologic reconstructive surgery.Level of EvidenceNA

The Occipital Artery-Based Fascial Flap for Ear Reconstruction.

The temporoparietal fascia flap is frequently used in ear reconstruction. When the temporoparietal fascia flap is unavailable, options for primary or secondary salvage reconstruction are limited. In these patients, an inferiorly based occipital artery fascia transpositional flap is a good alternative for soft-tissue coverage over a framework. This article describes the use of the occipital artery fascia flap for ear reconstruction in conjunction with a porous polyethylene framework. The authors included all patients who underwent occipital artery fascia flap surgery with a porous polyethylene framework for ear reconstruction performed by the first author from 1992 to 2017. A total of 83 patients received an occipital artery fascia flap: 24 for primary microtia reconstruction and 59 for revision or salvage of unsatisfactory results. All had contraindications for temporoparietal fascia flap use: prior use, flap injury from previous surgery, trauma, inappropriate flap location, or inadequate flap perfusion. Twelve patients (14 percent) developed occipital artery fascia flap complications (infection or necrosis) and underwent further revision to achieve satisfactory results. Given the paucity of reported techniques for large-scale auricular salvage/revision, the authors offer a versatile option that remains available when other conventional flaps are unavailable. The occipital artery fascia flap may be used with either alloplastic or autologous frameworks. Therapeutic, IV.

Side-Door Temporoparietal Fascia Flap: A Novel Strategy for Anterior Skull Base Reconstruction

The armamentarium for anterior skull base (ASB) reconstruction includes a variegate spectrum of grafts, endonasal pedicled flaps, regional pedicled flaps, and free flaps, which are selected to face specific scenarios. The use of a vascularized flap in case of large ABS defects ensures an adequate blood supply. The aim of this study was to evaluate the possible role of temporoparietal fascia flap (TPFF) in ASB reconstruction. Eight fresh-frozen head specimens were dissected to evaluate the adequacy of TPFF and pericranial flap (PF) for the reconstruction of ASB defects. The percentage of coverage of the ASB was calculated for TPFF and PF. An anatomic-radiologic analysis was performed to provide useful practical information for flap harvesting and positioning. The TPFF was easily transposed to the ABS defect through an epidural corridor; the edges of the TPFF were successfully placed in the intradural space, in the epidural space, or on the extracranial surface of the ABS defect. The PF was particularly adequate for median defects, and the TPFF was shown to be useful also in cases with paramedian-supraorbital extension. The median percentage of coverage of the ASB was significantly higher for TPFF (85.1%) than PF (65.7%) (P= 0.018). The supraorbital epidural corridor is a possible novel pathway for transposition of the TPFF for ASB reconstruction. Side-door TPFF was shown to be an ideal choice for large ASB defect with lateral supraorbital extension and could be useful in the scenario of salvage reconstruction for recurrent ABS cerebrospinal fluid leak.

Chimeric temporopareital osteofascial and temporalis muscle flap; a novel method for the reconstruction of composite orbito-maxillary defects

Reconstruction of midface defects are extremely challenging owing to the lack of suitable vascularized local flaps. The temporoparietal fascia and temporalis muscle flaps make excellent choices for midface and orbito-maxillary reconstruction. The muscle provides adequate thickness while the fascia yields pliable soft tissues for lining the midface. The temporalis muscle can be divided antero-posteriorly in three parts and medio-laterally in two parts without losing its vascularity due to its segmental vascular supply. These versatile flaps can be used independently, combined or as chimeric flap based on its axial blood supply for the reconstruction of midface. When designed as a chimeric flap it makes an excellent choice for the reconstruction of composite midface defects. With the advent of micro vascular reconstruction these regional flaps are rarely used in maxillofacial reconstruction. We hereby present a case of composite orbito-maxillary defect reconstruction using a novel chimeric reverse temporalis muscle and temperopareital fascia flap with pedicled split calvarial bone.

Optimizing the Aesthetic Result of Parotidectomy with a Facelift Incision and Temporoparietal Fascia Flap.

The 3 most common problems after a parotidectomy are cheek contour deformity, Frey syndrome (gustatory sweating), and a visible scar on the neck. These problems can potentially be prevented by (1) facelift type incisions, which eliminate the neck incision and (2) interposition of temporoparietal fascia at the parotidectomy site that fills the defect and provides a barrier to aberrant neuronal regeneration. We followed 11 patients who underwent parotidectomy (9 superficial and 2 total parotidectomies) for a variety of parotid tumors between December 2001 and January 2018. Facelift type incisions were used in all patients, and temporoparietal fascia flaps were used to fill the parotidectomy defects. The last 6 patients were tested for objective evidence of Frey syndrome with the Minor Starch Iodine test. Patients were then followed for up to 7 years (11 months to 7 years, average 3 years). All patients had well-hidden scars and good contour of the cheeks. None of the patients developed subjective or objective evidence of Frey syndrome. This small series suggests that the aesthetic result after parotidectomy can be improved by using a facelift incision and placement of a temporoparietal fascia flap into the parotidectomy defect. Additionally, the tissue barrier thus provided may also help to prevent Frey syndrome.

Free Tissue Transfer for Upper Extremity Reconstruction.

With the advent of the Industrial Revolution, traumatic injuries of the upper extremity increased exponentially. As a result, surgeons began to reevaluate amputation as the standard of care. Following the Second World War, local and regional pedicled flaps became common forms of traumatic upper extremity reconstruction. Today, microsurgery offers an alternative when options lower on the reconstructive ladder have been exhausted or will not produce a desirable result. In this article, the authors review the use of free tissue transfer for upper extremity reconstruction. Flaps are categorized as fasciocutaneous, muscle, and functional tissue transfers. The thin pliable nature of fasciocutaneous flaps makes them ideal for aesthetically sensitive areas, such as the hand. The radial forearm, lateral arm, scapula, parascapular, anterolateral thigh, and temporoparietal fascia flaps are highlighted in this article. Muscle flaps are utilized for their bulk and size; the latissimus dorsi flap serves as a "workhorse" free muscle flap for upper extremity reconstruction. Other muscle flaps include the rectus abdominis and serratus anterior. Lastly, functional tissue transfers are used to restore active range of motion or bony integrity to the upper extremity. The innervated gracilis can be utilized in the forearm to restore finger flexion or extension. Transfer of vascularized bone such as the fibula may be used to correct large defects of the radius or ulna. Finally, replacement of "like with like" is embodied in toe-to-thumb transfers for reconstruction of digital amputations.

Donor Site Calcification and Deformation Following Microtia Repair in a Pediatric Patient With Mosaic Trisomy 22

A microtia, or small or abnormally formed pinna, is an uncommon congenital abnormality of the external ear which can present as an isolated defect or as part of an underlying clinical syndrome. External ear reconstruction is a possibility, with either an autologous or non-autologous framework. The Nagata type of autologous reconstruction is a multistage process whereby costal cartilage, temporoparietal fascia, and a full thickness skin graft are used to form a new pinna. Here, we present the unique case of a young female born with mosaic trisomy 22, an extremely rare genetic condition, and a right-sided microtia. Between the first and second stages of her reconstruction, an anterior chest wall deformation was observed, coupled with unusual dystrophic calcifications over the cartilage near the ribs and sternum.

Microtia Reconstruction in Hemifacial Microsomia Patients: Three Framework Coverage Techniques

Microtia with hemifacial microsomia is difficult to treat because of skin volume deficiency. To provide further information for coverage techniques in microtia reconstruction, the authors have reviewed and analyzed patients who underwent surgery at their center. A total 52 patients with microtia with hemifacial microsomia who underwent reconstruction between 2006 and 2016 were involved. Patients were reviewed retrospectively by examining medical records and photographic data. All reconstructed cases were followed for 6 months to 10 years (median, 33 months). The average (median) surgeon's satisfaction score was 8.2 (median, 9) for the embedded and elevation technique (n = 23); 7.89 (median, 8) for the temporoparietal fascia flap technique (n = 10); and 6.30 (median, 7) for the subfascial expansion technique (n = 19). The median score difference between the embedding and subfascial expansion techniques was statistically significant (p = 0.03). Major factors that deteriorated aesthetic outcomes were large reconstructed ears (11 cases), cartilage framework resorption (11 cases), mismatched skin color (eight cases), different axis (seven cases), and different shapes (five cases). Mismatched skin color was significant in cases treated with the fascia flap technique (p < 0.0001), whereas cartilage framework resorption was significant in cases treated with the tissue expansion technique (p = 0.004). To obtain better aesthetic outcomes, the embedding technique should be used when the patient shows a mild to moderate degree of low hairline and usable remnant vestiges. In cases showing severe degrees of associated anomalies, the temporoparietal fascia flap technique should be used. Therapeutic, III.

A study on newer technique for reconstruction of pre auricular soft tissue defect with temporo-parietal fascia flap (Khabeer’s flap)

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; A pre auricular sinus is a congenital abnormality, which occurs due to failure of fusion of primitive tubercles from which pinna develops. Pre auricular sinuses are usually asymptomatic and when symptomatic present usually as discharging sinus, associated with abscess formation anterior to root of helix. Symptomatic pre auricular sinus requires surgical excision to prevent recurrence and reinfection. Treatment of pre auricular sinus by conventional methods usually presents a dead space due to removal of sinus tract. The present study is to overcome this defect by a superficial temporalartery based temporo-parietal fascia flap or Khabeer’s flap. The objective of this study is to describe a novel technique for excision of pre auricular sinus using supra auricular approach and using a temporo-parietal fascia flap for covering the defect created after excision of pre auricular sinus.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective study was carried out in Department of Otorhinolaryngology, Gandhi Medical College/Gandhi Hospital Secunderabad from 2014 to 2017. All the patients admitted with symptomatic pre auricular sinus underwent surgical excision by supra auricular approach and at the end superficial temporal artery based flap was placed to fill the dead space. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 20 pre auricular sinuses were operated during the study period. There were no recurrences, no collection of serous fluid and no cosmetic defect post operatively in any of the study subject.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The newer approach was found to be safe as it does not confer any complications post operatively and can be used for management of pre auricular sinus.&lt;/p&gt;

Anatomy of the superficial temporal artery in patients with unilateral microtia

This retrospective study evaluated the anatomical distribution of the superficial temporal artery (STA) in supply of the temporoparietal fascial (TPF) flap for use in patients with unilateral microtia undergoing reconstruction. We aimed to determine whether embryologic arrest of pharyngeal arch development would lead to aberrant STA, which impedes reliable harvest of the TPF flap in patients requiring microtia repair. CT angiograms (CTAs) and 3D reconstruction of the face and neck of 41 patients with microtia, aged 6-21 years, were examined. The number of STA branches, branching pattern, vessel diameter, and the presence or absence of the external auditory canal atresia were documented. The STA crosses the zygoma on average 4mm more anterior to the porion (anterior-inferior lip of the tympanic part of the temporal bone) on the side with microtia compared to the nonmicrotia side. There were no statistically significant differences between vessel caliber or STA branches between the two sides. The STA is anatomically reliable for inclusion in TPF flaps, which is used for auricular reconstruction in patients with microtia. A TPF flap can be safely harvested by the routine technique; however, surgeons should be cognizant of the STA coursing more anteriorly on the microtia ear.

Treatment options for partial auricle reconstruction: a prospective study of outcomes and patient satisfaction.

To evaluate the various methods and outcomes of post-traumatic partial auricle wound reconstruction, and to review the benefit to the patient's quality of life and their psychological improvement after the operation. The prospective study included patients who suffered from post-traumatic partial auricular wounds. The defects were repaired using various techniques including simple local cutaneous advancement flaps, tube flaps, cartilage framework using conchal and costal cartilage with local skin flap cover. A total of 18 patients were included, with a male predominance (sex ratio: 7:2), mean age with standard deviation of 31.66 ±9.27 years. Causes included road traffic accident (RTA), assault, human and insect bite and avulsion injuries. Injuries were sustained in the upper third of the auricle (n=8); middle third (n=5), lower third (n=3), and upper two-thirds (n=2). Out of the 18 patients, wound were repaired using post auricular mastoid skin flap (n=7); local superior and inferior chondrocutaneous flap (n=3); costal cartilage as a cartilage framework (n=4), temporoparietal fascia used to cover the costal cartilage graft (n=1), and conchal cartilage as a cartilage framework (n=3). In our study 13/18 patients were 'highly satisfied' with the aesthetic outcome, 3/18 were 'moderately satisfied', and 2/18 were 'slightly satisfied'. None were dissatisfied by the postoperative result. In terms of objective assessment, patient outcome in two patients was graded 'good' while the outcome of remaining patients (n=16) was graded as 'excellent'. The use of skin flaps in the post-auricular region and the mastoid region associated with or without cartilage framework yields good cosmetic and functional result. The various techniques used for ear reconstruction yielded 100% satisfactory results in terms of functional outcome as well as boosting the confidence of patients.

Classification and Microvascular Flap Selection for Anterior Cranial Fossa Reconstruction.

Microvascular reconstruction of the anterior cranial fossa (ACF) creates difficult challenges. Reconstructive goals and flap selection vary based on the defect location within the ACF. This study evaluates the feasibility and reliability of free tissue transfer for salvage reconstruction of low, middle, and high ACF defects. A retrospective review was performed. Reconstructions were anatomically classified as low (anterior skull base), middle (frontal bar/sinus), and high (frontal bone/soft tissue). Subjects were evaluated based on pathologic indication and goal, type of flap used, and complications observed. Eleven flaps in 10 subjects were identified and anatomic sites included: low (n = 5), middle (n = 3), and high (n = 3). Eight of 11 reconstructions utilized osteocutaneous flaps including the osteocutaneous radial forearm free flap (OCRFFF) (n = 7) and fibula (n = 1). Other reconstructions included a split calvarial graft wrapped within a temporoparietal fascia free flap (n = 1), latissimus myocutaneous flap (n = 1), and rectus abdominis myofascial flap (n = 1). All 11 flaps were successful without microvascular compromise. No complications were observed in the high and middle ACF defect groups. Two of five flaps in the low defect group using OCRFFF flaps failed to achieve surgical goals despite demonstrating healthy flaps upon re-exploration. Complications included persistent cerebrospinal fluid leak (n = 1) and pneumocephalus (n = 1), requiring flap repositioning in one subject and a second microvascular flap in the second subject to achieve surgical goals. In our experience, osteocutaneous flaps (especially the OCRFFF) are preferred for complete autologous reconstruction of high and middle ACF defects. Low skull base defects are more difficult to reconstruct, and consideration of free muscle flaps (no bone) should be weighed as an option in this anatomic area.

The Use of Temporoparietal Fascia Flap for Surgical Treatment of Traumatic Auricle Defects.

Background:Auricular reconstruction is 1 of the biggest challenges of facial plastic surgery. The aim of this study was to evaluate the efficacy of 1-stage reconstruction of an auricle using a temporoparietal fascia flap (TPFF).Methods:In this nonrandomized study, autologous auricle bodies with emergency condition and cartilaginous graft from projection of a costal arch from the VI–VII ribs were used. Temporal fascia sample with vascular pedicle (a temporal artery with the accompanying veins) by the Z-shaped incision of skin in temporal area for auricular reconstruction was extracted. Skin grafts were taken from the supraclavicular area or from the left or right flank. Grafts of partial auricle bodies (n = 8) along with cartilaginous framework from a costal arch (n = 21) were used for auricle reconstruction. The follow-up period studied after 6 months in 29 operated patients.Results:The graft of partial auricle bodies or the graft of a cartilaginous framework from a costal arch presented a perfect auricular reconstruction. By avoiding a difficult microsurgery and its possible complications, the use of TPFF led to beneficial results in 75% and 90.4% of cases, respectively. Overall, no major complication (alopecia, hematoma, or necrosis) occurred, and further surgery was not required.Conclusion:TPFF is a technique of choice for surgical treatment of traumatic auricle defects.

Tragus formation during concha-type microtia repair using a chondrocutaneous island flap.

Formation of an ideally-shaped tragus remains one of the most challenging issues during staged tragus reconstruction in microtia patients. The authors describe a new method used to treat a unique case of concha-type microtia in which the 10-year-old male patient had only a portion of pre-existing cartilage at the tragus site. An anomalous skin lump was also present. During the initial stages of the reconstruction, the two-stage Nagata method was used for surgical correction of the microtia. An autologous rib cartilage graft was used to form the ear framework. A temporoparietal fascia flap was also constructed. Remnant skin tags and anomalous cartilage that accompany microtia are usually removed during microtia repair. However, the cartilage and skin lump were preserved during the reconstruction. The skin lump was later used to form a vascularized chondrocutaneous island flap that supplemented the portion of cartilage during tragus formation. The result was a new tragus that was satisfactorily improved in both size and shape. Patients with concha-type microtia may benefit from the use of this new method for tragus formation.