We present five patients whom we applied temporoparietal fascial flap successfully with minimal donor morbidity. Covered with a tpf flap based on parietal branch of superficial temporal artery. It is the only singlelayered fascial flap that can be transposed into the craniofacial and head and. Reconstruction of the orbit with a temporalis muscle flap after. The temporoparietal fascia flap is one of the most versatile flaps in head and neck reconstruction. The temporalis muscle lies deep to the temporoparietal fascia.
Superficial temporal artery flap for reconstruction of complex facial. High voltage electric burn repair of the forehead by. To describe the use of the temporoparietal fascial. Tpff temporoparietal fascial flap anatomy acronymfinder. The temporoparietal fascial flap and the temporalis muscle. The temporoparietal fascial flap, on the other hand, is also an axial flap but is based on the superficial temporal vessels. Recent trends seem to favor free flap reconstruction for hard palate defects, when the temporoparietal fascial tpf flap or temporalis muscle tm flap are viable options affording a quicker, more efficient alternative for reconstruction. Rethinking burn patient monitoring to prevent orbital. It provides a thin sheet of vascularized fascia based on the superficial temporal artery and vein. All patients underwent periorbital reconstruction using a bifurcated superficial temporal artery island flap to reconstruct the eyebrows, correct the lagophthalmos, and release the ectropion in both the upper and the lower eyelids. Read the pedicled temporoparietal fascial flap for complex midfacial reconstruction, operative techniques in otolaryngologyhead and neck surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. The bony portion was inserted into the defect and the periosteum sutured to mastoid fascia. 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.
The temporoparietal fascia flap tpff is a versatile tool in head and neck reconstruction. The workhorse from above, operative techniques in otolaryngologyhead and neck surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at. Fascial flaps offer ideal coverage solutions for wounds where a gliding surface is needed such as tendons, joints, and no bulk is necessary or is to be avoided. Transplantation and transposition of the temporoparietal. Four cases are presented to illustrate possible variables in orbital reconstruction. The versatile use of temporoparietal fascial flap europe. Fascial flaps were used to resurface the orbital cavity in 4 cases, while. Posttraumatic eyebrow reconstruction with hairbearing. Monks described the flap at the end of the nineteenth century for the use of reconstruction of eyelid defects as well to reconstruct auricular defects. After wide elevation of the scalp flap at the subcutaneous plane, the sta trajectory was fully visualized and the distal. Pdf share on tweeters share on facebook share on linkedin share on. A variety of island flaps can be based on the superficial temporal artery with variable tissue composition. Pdf reverse temporalis muscle flap for the reconstruction of. The temporoparietal fascial flap is a viable alternative to free flaps for orbitomaxillary defects when orbital resection is limited, when obturator reconstruction is desired, or when.
Burn ear reconstruction using porous polyethylene implants. Jan 12, 2015 the temporoparietal fascia flap is one of the most versatile flaps in head and neck reconstruction. The temporoparietal fascial flap is useful for the reconstruction of regional defects involving the ear, orbit or cheek. To describe the use of the temporoparietal fascial flap tpf in the reconstruction of extensive lower eyelid defects in a functioning eye. The temporoparietal fascial flap is a thin, pliable, wellvascularized, locoregional flap that can be a reasonable alternative to traditional free flap reconstruction, but its utility for reconstruction of orbitomaxillary defects is often overlooked. In the remaining patients, coverage of the implant was achieved by local advancement flaps. Temporoparietal fascial flap in orbital reconstruction.
B schematic representation of eyebrow reconstruction with hairbearing temporoparietal fascia flap. Jun 14, 2016 temporalis muscle flap and temporoparietal fascia flap figure 41. If harvested to the midline, the temporoparietal flap provides a thin wellvascularized fascial flap that is easily rotated to cover orbital defects extending to the nose, cheek defects extending to the oral commissure, and intraoral defects over the body of the mandible. This thin, pliable, and highly vascularized flap, accepts skin grafts on both sides. Sep 01, 2000 read the pedicled temporoparietal fascial flap for complex midfacial reconstruction, operative techniques in otolaryngologyhead and neck surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Its main vascular supply comes from the superficial temporal artery and vein. Bifurcated superficial temporal artery island flap for the. Posttraumatic eyebrow reconstruction with hairbearing temporoparietal fascia flap 109 einstein. Objective to evaluate the success of the temporoparietal fascial flap tpff in the primary or secondary reconstruction of difficult orbital defects and to rev. The temporoparietal fascial flap, on the other hand, is. Pdf reconstruction of the orbit with a temporalis muscle flap.
Temporoparietal fascial flap is rotated into the orbit to line the orbital walls and sutured to the pericranial flaps with adsorbable sutures. Temporoparietal fascia flap iowa head and neck protocols. Temporalis muscle flap and temporoparietal fascia flap. The vascular supply is the deep temporal artery, which originates from the internal maxillary artery fig. A large amount of thin tissue is readily available.
A facial extension from the temporoparietal fascia was added to the flap when needed for reconstruction. Variables examined include the location of defects, the success of flap. The endoscope can provide a clear view with a minimal incision, making temporoparietal fascial. The temporal muscle fascia lies deep to the tpf over the temporalis muscle. Complex reconstruction of the orbitofrontal regions using. Reconstruction of total lower eyelid defects with the. Temporalis muscle flap and temporoparietal fascia flap ento key. In conclusion, the temporoparietal fascial flap is thin, pliable, and well vascularized with long pedicle, and it provides resistant coverage to the recipient site from infection. The advent of microvascular surgery has renewed interest in the vascular supply of the temporal region as a potential free flap donor site. Posttraumatic eyebrow reconstruction with hairbearing temporoparietal fascia flap 3 einstein the island of hairbearing scalp flap was incised up to the left ear, however, preserving the sta. Seventytwo patients underwent facial reconstruction using a superficial temporal artery island flap from october 2010 to october 2014. Temporoparietal fascial flap for reconstruction of open. Temporoparietal fascial flap how is temporoparietal fascial.
Pedicled temporoparietal galeal flap for reconstruction of. This report details our experience with the use of the temporoparietal fascia flap in different scenarios of reconstruction and to discuss our technique of harvest, clinical applications, and. Due to the fact that it is extremely well vascularised and thin, it may be used as a venous. The temporoparietal galea flap has been rediscovered as a useful tissue transfer technique. Eleven temporoparietal fascial flaps were performed. Extended versions that include galea can reach to the upper lip and into the oral cavity. The temporoparietal fascial flap is an alternative to free. We present a surgical case report of a 73yearold female with melanoma of the left lower eyelid.
Pdf reconstruction of total lower eyelid defects with. Jun 01, 2000 read the temporoparietal fascial flap in head and neck reconstruction. A temporoparietal fascial flap based on a defectmatched section of temporoparietal bone was created, with fascial and bony apposition left intact to maintain vascularization. Flap was successfully transferred with complete bone integration. A small opening is made in the lateral orbital wall to pass this flap into the orbit. Opting for a regional flap over a free flap also avoids the. Temporoparietal fascial flap was a viable option for subtle orbital and malar contour defects. The authors have used this flap for orbital reconstruction after exenteration in 6. The temporoparietal fascial flap represents the middle of 5 layers. 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 temporoparietal fascial flap tpff has been used as a pedicled, free, or composite flap with calvarial bone or hairbearing skin in reconstruction of the defects of periorbital, midfacial, auricular regions, and extremities. Although initially described more than a century ago to reconstruct an auricular horse bite defect, it was not until a sophisticated understanding of temporal anatomy was established in the midtwentieth century that surgeons experimented more prolifically with this flap, and thereby.
Superficial temporal artery flap for reconstruction of. Two patients underwent bilateral periorbital flap reconstruction. Versatility of temporal muscle and fascial flaps journal of plastic. The use of the temporoparietal fascial flap in preventing. Vascularized calvarial bone flaps and midface reconstruction. The temporalis muscle flap comprises the temporalis muscle, with or without the overlying temporalis fascia.
The temporoparietal fascia flap has a wide variety of applications for reconstruction of defects of the cheek, ear, and orbit. The overlying fasciocutaneous portion of the flap was. The improved anatomical knowledge of the temporoparietal fascia has opened a wide variety of clinical applications for the flap based on this tissue. Orbital reconstruction was performed with a left tpff and splitthickness skin graft. The temporoparietal fascia flap was planned in such way that the skin island was left on the flap of the posterior branch of the superficial temporal artery. It is commonly used to reconstruct other areas after removal of a tumor. To evaluate the success of the temporopa rietal fascial.
Prevention with temporoparietal fascial flap interposition. Variables examined include the location of defects, the success of flap survival in orbital cavities after primary or secondary. The flap is accessed via a hemicoronal skin incision commencing in a preauricular skin crease just below the level of the zygoma and placed behind the hairline for cosmetic reasons figure 4. Temporoparietal galeal flap provides a reliable source of pliable, well vascularized local tissue capable of reconstructing contracted eye socket and periorbital deformities due to trauma. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Adequate exposure for raising this flap was obtained using standard incisions for the otologic procedures.
Temporoparietal fascia flap reconstruction of a mohs defect of the ear freys syndrome. Pdf this study presents the role of the temporalis muscle flap in primary. After the excision and reconstruction in a single surgical stage, the postoperative result was favorable, the 12 months assessment showing that the patient was satisfied with the aesthetic aspect. The lower eyelid was resected, and a composite nasal cartilagemucosa graft, a skin graft, and a tpf were used to reconstruct the lower. 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 temporoparietal fascial flap tpff is a reliable and strong flap, which may be used pedicled or free to treat a wide variety of difficult problems. The use of the temporoparietal fascial flap in preventing csf. Use of composite osteotemporoparietal fascia flap for. Canal walldown tympanoplasty with softwall reconstruction. Reconstruction of fullthickness ear defects using conchal. Despite these descriptions of its use in head and neck reconstruction, the flap remained an obscure and underused tool until an explosion of new descriptions of it. They can be used for defect reconstruction, cavity resurfacing, facial hair restoration, or contracture release.
The most common use of this flap is as a carrier of a skin graft. Temporoparietal fascia flap postoperative instructions. The temporoparietal fascial flap is a thin, pliable, wellvascularized, locoregional flap that can be a reasonable alternative to traditional free flap reconstruction, but its utility for. The versatility of the temporoparietal fascia flap in head. Posttraumatic eyebrow reconstruction with hair bearing. We conclude that the use of conchal cartilage graft and temporoparietal fascial flap with fullthickness skin graft is useful in onestage reconstruction of mediumsized fullthickness defects of the ear. Like the tpff, the tmf is a reliable, myofascial flap that was also described more than a century ago. In 1898, the temporoparietal fascia flap was described nearly simultaneously for reconstruction of the external ear after a horse bite and for reconstruction of the lower eyelid. Above the temporal line, the galeal layer lies between the subcutaneous tissue and the subgaleal fascia, also called the loose areolar tissue component of the pericranium. The temporoparietal fascial plane lies between the subcutaneous tissue and superficial layer of the deep temporal fascia below the temporal line. Temporalis muscle flap vula university of cape town. Temporoparietal fascial flap in orbital reconstruction oncology.
The temporoparietal fascia tpf is an extension of the subcutaneous musculoaponeurotic system smas inferiorly and the galea aponeurotica superiorly. The workhorse from above, operative techniques in otolaryngologyhead and neck surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. This fascial flap provides a wide surface area of tissue on a narrowbased pedicle capable of a wide arc of rotation. A temporoparietal fascia flap is a method of borrowing tissue from under the scalp to reconstruct another area of the face or mouth. Extratemporoparietal fascia was harvested and rotated to cover the medullary surface of the bone flap. The use of the temporoparietal fascia flap in various. A the temporoparietal fascia is elevated with a skin. The temporalis muscle flap and temporoparietal fascial flap. Read the temporoparietal fascial flap in head and neck reconstruction. The temporalis muscle flap comprises the temporalis muscle. Jun 04, 2018 in 1898, the temporoparietal fascia flap was described nearly simultaneously for reconstruction of the external ear after a horse bite and for reconstruction of the lower eyelid. It is an axial flap based on the anterior and posterior deep temporal arteries.
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. There were no complications related to the reconstruction. Application of both expanded cutaneous flap and temporoparietal fascia flap in ear reconstruction with medpor framework. The temporoparietal fascial flap is an alternative option for the reconstruction defects in patients treated for head and neck cancer. There were no surgical complications and excellent cosmetic result. Temporoparietal fascial flap in orbital reconstruction amy lai, md. Reverse temporalis muscle flap for the reconstruction of orbital exenteration defects. We compared the use of the pedicled temporoparietal fascial flap tpff with the use of free deep temporal fascia dtf in softwall reconstruction after canal walldown tympanoplasty.