We present a surgical case report of a 73yearold female with melanoma of the left lower eyelid. Temporoparietal fascia flap postoperative instructions. Covered with a tpf flap based on parietal branch of superficial temporal artery. 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. The temporoparietal fascial flap, on the other hand, is. 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. 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 commonly used to reconstruct other areas after removal of a tumor. The endoscope can provide a clear view with a minimal incision, making temporoparietal fascial. Variables examined include the location of defects, the success of flap survival in orbital cavities after primary or secondary. Posttraumatic eyebrow reconstruction with hairbearing temporoparietal fascia flap 109 einstein. 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. B schematic representation of eyebrow reconstruction with hairbearing temporoparietal fascia flap.
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. Use of composite osteotemporoparietal fascia flap for. 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. 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. 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.
Temporoparietal fascial flap was a viable option for subtle orbital and malar contour defects. The use of the temporoparietal fascial flap in preventing csf. Pdf reverse temporalis muscle flap for the reconstruction of. A small opening is made in the lateral orbital wall to pass this flap into the orbit.
The temporoparietal fascia tpf is an extension of the subcutaneous musculoaponeurotic system smas inferiorly and the galea aponeurotica superiorly. They can be used for defect reconstruction, cavity resurfacing, facial hair restoration, or contracture release. The lower eyelid was resected, and a composite nasal cartilagemucosa graft, a skin graft, and a tpf were used to reconstruct the lower. Temporoparietal fascia flap reconstruction of a mohs defect of the ear freys syndrome. 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 and the temporalis muscle. Read the temporoparietal fascial flap in head and neck reconstruction. 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.
Jun 01, 2000 read the temporoparietal fascial flap in head and neck reconstruction. 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. Objective to evaluate the success of the temporoparietal fascial flap tpff in the primary or secondary reconstruction of difficult orbital defects and to rev. Eleven temporoparietal fascial flaps were performed. 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.
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. This fascial flap provides a wide surface area of tissue on a narrowbased pedicle capable of a wide arc of rotation. High voltage electric burn repair of the forehead by. 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. Extratemporoparietal fascia was harvested and rotated to cover the medullary surface of the bone flap. We present five patients whom we applied temporoparietal fascial flap successfully with minimal donor morbidity. Application of both expanded cutaneous flap and temporoparietal fascia flap in ear reconstruction with medpor framework. The temporalis muscle flap comprises the temporalis muscle, with or without the overlying temporalis fascia. Temporalis muscle flap and temporoparietal fascia flap. The overlying fasciocutaneous portion of the flap was.
The temporoparietal fascial flap is an alternative to free. Pdf this study presents the role of the temporalis muscle flap in primary. It provides a thin sheet of vascularized fascia based on the superficial temporal artery and vein. Complex reconstruction of the orbitofrontal regions using. The temporoparietal fascial plane lies between the subcutaneous tissue and superficial layer of the deep temporal fascia below the temporal line. Superficial temporal artery flap for reconstruction of complex facial. Temporoparietal fascial flap in orbital reconstruction oncology. Due to the fact that it is extremely well vascularised and thin, it may be used as a venous. Prevention with temporoparietal fascial flap interposition. There were no surgical complications and excellent cosmetic result. Temporoparietal fascia flap iowa head and neck protocols. Opting for a regional flap over a free flap also avoids the. This thin, pliable, and highly vascularized flap, accepts skin grafts on both sides. The authors have used this flap for orbital reconstruction after exenteration in 6.
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. The use of the temporoparietal fascia flap in various. 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. After wide elevation of the scalp flap at the subcutaneous plane, the sta trajectory was fully visualized and the distal. Reconstruction of fullthickness ear defects using conchal. The temporoparietal fascia flap tpff is a versatile tool in head and neck reconstruction. A the temporoparietal fascia is elevated with a skin. 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. The temporoparietal fascial flap is useful for the reconstruction of regional defects involving the ear, orbit or cheek. 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.
Temporalis muscle flap and temporoparietal fascia flap ento key. 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. 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. The temporoparietal fascia flap is one of the most versatile flaps in head and neck reconstruction. The temporalis muscle flap comprises the temporalis muscle. Reconstruction of the orbit with a temporalis muscle flap after. The temporalis muscle flap and temporoparietal fascial flap. Posttraumatic eyebrow reconstruction with hair bearing. 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. 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. Temporoparietal fascial flap how is temporoparietal fascial. To describe the use of the temporoparietal fascial. Temporoparietal fascial flap is rotated into the orbit to line the orbital walls and sutured to the pericranial flaps with adsorbable sutures.
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 temporoparietal fascial flap is an alternative option for the reconstruction defects in patients treated for head and neck cancer. Orbital reconstruction was performed with a left tpff and splitthickness skin graft. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Temporalis muscle flap vula university of cape town. Burn ear reconstruction using porous polyethylene implants. It is an axial flap based on the anterior and posterior deep temporal arteries. 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.
The improved anatomical knowledge of the temporoparietal fascia has opened a wide variety of clinical applications for the flap based on this tissue. Canal walldown tympanoplasty with softwall reconstruction. Extended versions that include galea can reach to the upper lip and into the oral cavity. Four cases are presented to illustrate possible variables in orbital reconstruction. 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. Transplantation and transposition of the temporoparietal.
Variables examined include the location of defects, the success of flap. To evaluate the success of the temporopa rietal fascial. A temporoparietal fascial flap based on a defectmatched section of temporoparietal bone was created, with fascial and bony apposition left intact to maintain vascularization. Tpff temporoparietal fascial flap anatomy acronymfinder. 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.
The temporoparietal fascial flap represents the middle of 5 layers. Like the tpff, the tmf is a reliable, myofascial flap that was also described more than a century ago. The most common use of this flap is as a carrier of a skin graft. Vascularized calvarial bone flaps and midface reconstruction. Seventytwo patients underwent facial reconstruction using a superficial temporal artery island flap from october 2010 to october 2014. The temporalis muscle lies deep to the temporoparietal fascia.
Versatility of temporal muscle and fascial flaps journal of plastic. In the remaining patients, coverage of the implant was achieved by local advancement flaps. Reverse temporalis muscle flap for the reconstruction of orbital exenteration defects. The temporoparietal galea flap has been rediscovered as a useful tissue transfer technique. Two patients underwent bilateral periorbital flap reconstruction. The versatile use of temporoparietal fascial flap europe.
Temporoparietal fascial flap in orbital reconstruction. The temporal muscle fascia lies deep to the tpf over the temporalis muscle. 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. Flap was successfully transferred with complete bone integration. Temporoparietal fascial flap for reconstruction of open. The vascular supply is the deep temporal artery, which originates from the internal maxillary artery fig. Jun 14, 2016 temporalis muscle flap and temporoparietal fascia flap figure 41. 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. Superficial temporal artery flap for reconstruction of. It is the only singlelayered fascial flap that can be transposed into the craniofacial and head and.
Rethinking burn patient monitoring to prevent orbital. Pdf reconstruction of total lower eyelid defects with. Temporoparietal fascial flap in orbital reconstruction amy lai, md. Its main vascular supply comes from the superficial temporal artery and vein. A temporoparietal fascia flap is a method of borrowing tissue from under the scalp to reconstruct another area of the face or mouth. The temporoparietal fascial flap, on the other hand, is also an axial flap but is based on the superficial temporal vessels. A variety of island flaps can be based on the superficial temporal artery with variable tissue composition. Pdf share on tweeters share on facebook share on linkedin share on. Reconstruction of total lower eyelid defects with the. The use of the temporoparietal fascial flap in preventing. The versatility of the temporoparietal fascia flap in head.
Posttraumatic eyebrow reconstruction with hairbearing. A facial extension from the temporoparietal fascia was added to the flap when needed for reconstruction. There were no complications related to the reconstruction. The temporoparietal fascia flap has a wide variety of applications for reconstruction of defects of the cheek, ear, and orbit. 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. To describe the use of the temporoparietal fascial flap tpf in the reconstruction of extensive lower eyelid defects in a functioning eye. Jan 12, 2015 the temporoparietal fascia flap is one of the most versatile flaps in head and neck reconstruction. 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. Fascial flaps were used to resurface the orbital cavity in 4 cases, while. The advent of microvascular surgery has renewed interest in the vascular supply of the temporal region as a potential free flap donor site. 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.