Temporoparietal Fascial Flap Research Articles

Clinical application of temporoparietal fascial flap in the treatment of hand injuries and deformities

目的 介绍应用颞浅筋膜瓣修复手部创面的手术方法.方法对12例,其中手背或手指软组织缺损9例,手背或手指瘢痕挛缩形成爪形手畸形3例,采用游离颞浅筋膜瓣加全厚层植皮进行移植修复.结果 12例筋膜瓣及皮片全部成活.术后随访6个月.手背及手指外形无臃肿,移植组织柔软具有滑动性.手功能评定:良11例,中5例,差3例.两点分辨觉达5mm～7mm.颞部供区愈合好,无明显的秃发.结论游离颞浅筋膜瓣加全厚皮片移植修复手外伤或手部瘢痕切除后的软组织缺损是一种供区隐蔽,简单有效的理想手术方法。

Subtotal reconstruction of the burned auricle

The goal for external ear reconstruction is to restore the function of the helical rim in order to provide support for eyeglasses and to provide a cosmetically acceptable auricle. Reconstruction necessitates both flap coverage and flexible framework formation. This article reviews 22 patients who underwent subtotal reconstruction of the auricles after burns. The study was conducted from 1996 to 2003. The study group consisted of 14 male and 8 female patients aged 6–43 years (mean 21.9 years). Different modalities have been used: the temporoparietal fascial flap (eight patients), the subcutaneous pocket technique (11 patients), the pre-auricular skin flap (four patients), and the post-auricular skin flap (three patients). The flaps were used for coverage of fabricated autogenous cartilage in all patients. Both aesthetic and functional outcome was satisfactory.

Posterior meatal wall reconstruction using the temporoparietal fascia flap

Objectives: There are some general principles of tympanoplasty: complete removal of lesion, hearing improvement, quick epithelialization, and prevention of postoperative complications. Additionally, recovery of mastoid aeration is desirable. In the present study, we used the temporoparietal fascia flap (TPFF) for posterior meatal reconstruction for the open cavity to achieve these principles. Methods: The TPFF was used in 6 patients with cholesteatoma or cholesterol gramuloma for reconstruction of the posterior meatal wall. The skin of the posterior half of the external auditory meatus was elevated from the bony wall. After canal wall down tympanoplasty and mastoidectomy, the pedicled TPFF including the superficial temporal artery was raised ipsilaterally and rotated into the middle ear. The posterior meatal wall was reconstructed by gluing one side of the TPFF to the reverse side of the preserved posterior meatal wall skin. Results: Mean time to complete epithelialization of the meatal skin in these 6 patients was shorter than that of 27 patients who underwent the meatal reconstruction using the free deep temporal fascia (26 days vs 37 days) statistically. No postoperative infection in operated ears occurred. CT scans performed 1 year after the surgery revealed that recovery of mastoid aeration was observed in 2 patients despite thorough removal of the mucosa in the mastoid cavity Conclusion: The TPFF can provide optimal blood supply to the middle ear and external meatal skin. It is possible that the TPFF works positively not only for quick epithelialization and prevention of postoperative infection, but also for recovery of mastoid aeration.

Mucinous intestinal type adenocarcinoma of the sinonasal tract secondary to passive wood dust inhalation: case report

A 76-year-old female patient with a mucinous intestinal type adenocarcinoma of the sinonasal tract is described. The probable aetiology of passive hard wood dust inhalation, investigations carried out and subsequent surgical treatment using a transfacial access approach and a temporoparietal fascial composite free flap in conjunction with free auricular cartilage are described.

Invited Discussion: Eyebrow Reconstruction With Intermediate Hair From the Hairline of the Forehead on the Pedicled Temporoparietal Fascial Flap

From the Division of Plastic Surgery, The Johns Hopkins Hospital and School of Medicine, Baltimore, Maryland. Received January 2, 2003, and accepted for publication January 10, 2003. Address correspondence and reprint requests to Dr. James E. Vogel, Assistant Professor, Division of Plastic Surgery, The Johns Hopkins Hospital and School of Medicine, 1838 Greene Tree Road, Baltimore, Maryland 21208. Vogel JE. Invited Discussion: Eyebrow Reconstruction With Intermediate Hair From the Hairline of the Forehead on the Pedicled Temporoparietal Fascial Flap.

Eyebrow reconstruction with intermediate hair from the hairline of the forehead on the pedicled temporoparietal fascial flap.

Although various reconstructive procedures for the eyebrow have been reported, few have proved satisfactory for large-tissue defects. The authors describe two cases of eyebrow reconstruction with intermediate hair from the hairline of the forehead on the pedicled temporoparietal fascial flap (TPF flap) after malignant tumor resection. The first patient was a 24-year-old man with an adnexal carcinoma of the left eyebrow. An intermediate hair flap was prepared at the hairline of the forehead in accordance with the defect. The second patient was a 48-year-old woman with Bowen's disease of the left eyebrow. Tumor resection was performed on the frontal muscle with a 5-mm surgical margin. An intermediate hair flap was prepared at the hairline of the forehead in accordance with the defect. Both reconstructed eyebrows have maintained their shapes well. There have been several reports of the use of a TPF flap for eyebrow reconstruction, but none have used intermediate hair from the hairline. The authors are convinced that use of intermediate hair from the hairline of the forehead on the pedicled TPF flap is effective for reconstruction of the eyebrow and large defects extending to nonhairy subbrow skin.

Commentary on: "Reconstruction of full-thickness ear defects using conchal cartilage and pedicled temporoparietal fascia" by Hatoko et al.

The authors should be congratulated for reviewing their experience using ipsilateral conchal cartilage and a pedicled temporoparietal fascial flap in the reconstruction of ear defects of the superior third less than 2 cm in dimension. We agree with the authors that the temporoparietal fascial flap provides reliably vascularized fascia that readily accepts overlying skin grafts and that conchal cartilage will provide a stable skeleton for small auricular defects without creating deformities to the ear. The authors correctly note the problem of obtaining satisfactory color match with grafted skin. Our preference has been the use of postauricular skin on the anterior surface of the ear whenever possible. We make sure and elevate the skin adjacent to the defect and allow the temporoparietal fascia to span beyond the margin of the actual defect. We believe that this helps to minimize the indentation and demarcation between the normal and grafted portion of the reconstruction. The primary aesthetic criteria for auricular reconstruc

Reconstruction of full-thickness ear defects using conchal cartilage and pedicled temporoparietal fascia

We describe method for reconstructing full-thickness ear defects using conchal cartilage graft covered by a pedicled temporoparietal fascial flap with a full-thickness skin graft. We treated eight partial, full-thickness defects of the ear in eight patients, two males and six females. The patients' ages ranged from 10 to 68 years. In five patients, the ear defects were caused by malignant tumor resection (three) and trauma (two). In the remaining three patients, the defect was created after correction of congenital ear deformity (constricted ear). In all cases, the defect included the helical rim and involved the upper third of the ear. The defect size to be reconstructed ranged from 10×14 mm to 16×20 mm. The ipsilateral conchal cartilage could be harvested without any problems in all cases. Grafted skin was obtained from the lower lateral abdomen. In all cases, the blood supply to the fascial flap was good, and the grafted skin took completely. The post-operative course was uneventful in all donor sites for cartilage, temporoparietal fascia, and full-thickness skin. Post-operative shrinkage was not significant and the reconstructed ear was close to the expected contour and size. In all cases, the defects were reconstructed almost completely satisfactorily in terms of contour of the helical rim and support. Although the color match of the grafted skin was not ideal, all patients were satisfied with the results. No donor deformity of the conchal cartilage was found in any case, and the donor scar of the temporoparietal fascia was hidden by the hair. We conclude that the use of conchal cartilage graft and temporoparietal fascial flap with full-thickness skin graft is useful in one-stage reconstruction of medium-sized full-thickness defects of the ear.

Discussion: Temporoparietal fascia flaps and superficial musculoaponeurotic system plication in parotid surgery reduces Frey's syndrome

J Oral Maxillofac Surg 60:1297-1298, 2002

Temporoparietal fascia flaps and superficial musculoaponeurotic system plication in parotid surgery reduces Frey's syndrome

Purpose: The purpose of this retrospective study was to evaluate the incidence of Frey's syndrome after parotid gland surgery with elevation of a skin flap versus the interposition of musculoaponeurotic tissue between the skin and the facial nerve. Materials and Methods: The standard skin flap was used in 122 patients (1981 to 1989), whereas interposition of temporoparietal galea or superficial musculoaponeurotic system was performed in 146 consecutive patients (1989 to 1998). Results: The incidence of Frey's syndrome was reduced from 33% to 4% with the use of a musculoaponeurotic layer, and the mean duration of postoperative facial nerve paresis decreased from 3 months to 6 weeks. Conclusions: Consideration should be given to the use of an interpositional layer of tissue between the facial nerve and the skin flap to reduce the incidence of Frey's syndrome after parotid gland surgery. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:1284-1297, 2002

The combined posterior temporoparietal and galeal fascial flap: a new flap in the elevation of the constructed auricle (second stage of microtia correction).

Over the past few years, the technique of elevating the buried ear framework in the second stage of microtia correction has shifted from skin grafting to the use of flaps and cartilage blocks in the retroauricular sulcus. While the temporoparietal fascial flap should be reserved for secondary procedures and the treatment of complications, the mastoid fascial flap is inadequate by itself and needs an additional cartilage graft. Here, we describe a new flap, the combined posterior temporoparietal and galeal fascial flap, for the elevation of the buried ear cartilage. The flap is robust, with a dependable blood supply based on the posterior branches of the superficial temporal artery. In four cases the flap was rolled up and inset into the retroauricular sulcus, while in three cases an additional conchal cartilage graft was inserted into the roll. All the patients had satisfactory ear projection at follow-up 10-14 months postoperatively. We discuss the surgical technique and the advantages of this flap. We believe that this new flap, which has not been described before, has the potential to replace other flaps in the second stage of microtia correction.

Balanced auricular reconstruction in dystopic microtia with the presence of the external auditory canal.

This article presents a new repositioning method in dystopic microtia (low-set microtia, anteriorly tilted microtia, or both) with the presence of the external auditory canal. In the case of low-set malformations, the dystopic auricular canal complex was freed from adjacent bony structure, shifted upward, and anchored to the thick periosteum of the suprameatal triangle or the adjacent superior portion of the temporal bone with nonabsorbable sutures. When the auricular vestige was large and dystopia was severe, the complex was shifted with attachment of the temporoparietal fascia on its cranial part. Meanwhile, when the auricular vestige was small and dystopia was mild, the complex was shifted without attachment of the temporoparietal fascia. Then, the ear framework fabricated with autogenous costal cartilage was positioned and wrapped with the temporoparietal fascial flap. In the case of anteriorly tilted malformations, the dystopic complex was freed, shifted posteriorly, and anchored to the periosteum of the suprameatal triangle. Preauricular dead space, resulting from shifting the complex, was obliterated with pieces of costal cartilage. Simultaneously, the ear framework was placed and wrapped with the temporoparietal fascial flap. No skin necrosis of the shifted complexes occurred in any of the cases. In one case, the facial nerve was transected during dissection and reanastomosed. Upward repositioning distances in low-set microtias were between 1 and 3.5 cm. Posteriorly repositioning distances in anteriorly tilted microtias were 2 and 3 cm. Thirteen patients with low-set malformations, two patients with anteriorly tilted malformations, and three patients with low-set and anteriorly tilted malformations underwent reconstructive operations. The new repositioning method is relatively simple, safe, and effective.

Evaluation of scars after harvest of the temporoparietal fascial flap depending on the design of the skin incision.

The authors evaluated the conspicuousness of the temporal scar caused by two incision patterns after harvesting the temporoparietal fascial flap: a straight incision and a zigzag incision. The 27 scars of 27 patients were examined in this study. Fifteen patients underwent a straight incision and 12 patients had a zigzag incision. This study showed that the zigzag incision resulted in more conspicuous scars than the straight incision and that this effect was more evident in younger patients than in older patients, at least in Japanese. In a comparison of older patients and younger patients irrespective of the skin incision patterns, the scars were substantially more conspicuous in the younger patients. A simple and short incision is preferred when harvesting the temporoparietal fascial flap and more careful management is required for young patients.

Firm elevation of the auricle in reconstruction of microtia with a retroauricular fascial flap wrapping an autogenous cartilage wedge

During conventional reconstruction of the auricle in patients with microtia, simply separating the auricle from the mastoid region with a full-thickness skin graft usually fails to create firm elevation and sufficient projection. To achieve frontal symmetry is difficult, and sometimes the normal auricle needs to be set back. We reconstructed the auricle in patients with microtia in two major stages using a modified Nagata's method. Using a wide W-incision skin flap, the first stage includes implantation of a cartilage framework and transposition of the ear lobule. Our modification lies in the second stage. Instead of using the superficial temporoparietal fascial flap, we elevated a retroauricular fascial flap from the mastoid region, turning it over to wrap an autogenous costal-cartilage wedge, and covered it with a full-thickness skin graft. Between June 1996 and May 1999, eight patients underwent this operation. All the fascial flaps and overlying full-thickness skin grafts survived well. The advantages of our technique include firm elevation, good frontal projection and a natural appearance of the posterior aspect of the ear. Additionally, by using this fast and practical procedure, we avoid creating additional scars on the scalp and preserve the superficial temporoparietal fascia and superficial temporal vessels.

Endoscopic harvest of free temporoparietal fascial flap to improve donor-site morbidity.

Yano, Hiroki M.D.; Fukui, Masashi M.D.; Yamada, Kazuhiko M.D.; Nishimura, Gozo M.D. Author Information

Endoscopic-assisted harvest of the temporoparietal fascial flap.

Elevation of the temporoparietal fascial flap by conventional T or Y incisions in the temporal region frequently leaves conspicuous scarring, hair thinning, or baldness. To avoid such undesirable effects, endoscopic-assisted harvest of the temporoparietal fascial flap was performed in 9 patients with microtia. Through two horizontal incisions in the temporal region, the temporoparietal fascia was dissected, and the flap was harvested using bipolar scissors and coagulating shears. Flaps were dissected and harvested successfully without any complications in 7 patients, although extra incisions were required to facilitate coagulation in 2 patients. The authors introduce this harvesting technique and describe some representative cases. Using endoscopic guidance, this is a versatile, safe procedure with minimal morbidity, and is applicable to other reconstructive procedures that require a temporoparietal fascial flap, including the free flap.

The pedicled temporoparietal fascial flap for complex midfacial reconstruction

Reconstruction of the maxillary suprastructure, the periorbital region, and the lateral pyriform aperature are not commonly performed at the time of oncologic ablative surgery. A significant reason for this practice relates to a paucity of local vascularized soft tissue flaps that can support the reconstruction. Because the local soft tissues do not lend themselves to pedicled or rotational transfer, the most commonly used vascularized tissue for midface reconstruction had been the free tissue transfer. In this article, the pedicled temporoparietal fascial flap is described for midface reconstruction. The donor site from the undersurface of the scalp in the posterior temporal and anterior parietal regions permits the development of a highly vascular, durable, and very supple flap. This flap, pedicled on the superficial temporal artery and vein, can be rotated from the preauricular region, under the zygoma, and through the lateral wall of the maxillary sinus into the midface region for use in supporting bone or skin grafts. The temporoparietal donor site also exposes the appropriate area of the calvarium for external table bone grafts, which can be used in maxillary suprastructure replacement. With this flap, the need for microvascular transfer can be reduced or eliminated in those midface defects limited to the maxillary suprastructure, the periorbital region, and the lateral pyriform aperature.

Temporoparietal Fascial Flap in Orbital Reconstruction

To evaluate the success of the temporoparietal fascial flap (TPFF) in the primary or secondary reconstruction of difficult orbital defects and to review the surgical techniques. Retrospective analysis. Tertiary medical center. Nine patients with diverse orbital cavity or periorbital soft tissue and bony defects due to trauma, benign or malignant neoplasms, and radiation treatment. Temporoparietal fascial flap anatomy and techniques of harvest and inset are reviewed in detail. Four cases are presented to illustrate possible variables in orbital reconstruction. Variables examined include the location of defects, the success of flap survival in orbital cavities after primary or secondary reconstruction, the effects of prior irradiation on flap survival, and the possibility of concurrent osteointegrated implant placement with TPFF reconstruction. Functional and aesthetic outcomes were determined by physical examination and preoperative and postoperative photographs. All patients had successful transfer of TPFF grafts without flap compromise. Temporoparietal fascial flap was a viable option for subtle orbital and malar contour defects. In chronically inflamed wounds such as with osteoradionecrosis and orbitoantral fistula, TPFF successfully restored vascularity, obliterated the defects, and enabled the placement of osteointegrated implants. The TPFF also supported the concurrent placement of a free calvarial bone graft. Finally, split-thickness skin grafted onto a pedicled TPFF showed 100% survival. The TPFF is one of the most reliable and versatile regional flaps in the head and neck for orbital reconstruction. This study presents the use of TPFF in a variety of orbital defects, from lateral bony rim defects to total exenteration. Timing of repair in this study spans from immediate reconstruction to reconstruction delayed more than 50 years after the initial injury. In all cases, reconstruction with TPFF resulted in improved bony and soft tissue contours, and incurred minimal morbidity.

The temporoparietal fascial flap in head and neck reconstruction: The workhorse from above

Just as the pectoralic myocutaneous flap has become the flap of choice for a variety of head and neck defects within its range, the temporoparietal fascial flap (TPF flap) is remarkably dexterous to many types of tissue at distinct ear, nose, throat, and facial positions. Whether it is a soft-tissue, bony, cartilage, or combination reconstructive deficit, the TPF flap is adaptable. Furthermore, it supplies blood flow in poor healing situations such as in irradiated or infected fields—even for maxillary or mandible bony tissue. Just as the pectoralic myocutaneous flap has become the flap of choice for a variety of head and neck defects within its range, the temporoparietal fascial flap (TPF flap) is remarkably dexterous to many types of tissue at distinct ear, nose, throat, and facial positions. Whether it is a soft-tissue, bony, cartilage, or combination reconstructive deficit, the TPF flap is adaptable. Furthermore, it supplies blood flow in poor healing situations such as in irradiated or infected fields—even for maxillary or mandible bony tissue.

Prophylaxis against Frey's syndrome in parotid surgery.

In 1990 the authors reported their preliminary study of the prevention of Frey's syndrome in 55 patients utilizing a superficial musculoaponeurotic system (SMAS) flap in parotid gland surgery. During the past 10 years, numerous studies have supported their original thesis that interposition of living tissue between the resected gland bed and the skin could prevent the development of this complication. The authors have expanded their own patient population and now consider this a definitive study on the prevention of Frey's syndrome. A total of 160 patients are presented with a follow-up period of 5 to 22 years. All patients underwent subtotal or total parotidectomy performed by one of the authors. A history was acquired and testing for Frey's syndrome (Minor's starch iodine test) was performed. As a result of this approach, and in spite of the intensive search for it, no cases of Frey's syndrome were encountered. The hoped-for secondary benefit of preventing the postparotidectomy retromandibular depression was somewhat less satisfactory, although most patients remain satisfied with their appearance. The debilitating symptoms in Frey's syndrome, which is reported to have an incidence of 5% to 50% in the typical parotidectomy patient, can be avoided with thoughtful preoperative planning. The authors favor an aesthetic incision followed by the development of an SMAS flap. The parotidectomy is then performed using the surgeon's preferred technique. The SMAS flap is then placed into the bed of the resected parotid gland. This institutes a protective tissue barrier guarding against the aberrant anastomotic communication between the postganglionic secretomotor fibers intended for the parotid gland, and the now adjacent sweat glands. Their patient population is large enough to provide significant evidence that Frey's syndrome can be prevented, compared with a meta-analysis of parotid patients in multiple other studies in the literature. Assuming the patient's history and pathology does not preclude its use, the SMAS flap should be considered the standard of care for preventing Frey's syndrome in the postparotidectomy patient. If the SMAS flap is not available, a temporoparietal fascial flap has proved to be a good alternative.