The temporoparietal fascia flap (TPFF) is a versatile flap well recognized in the reconstruction of craniofacial defects. Most commonly, the TPFF is utilized in a pedicled fashion for the reconstruction of the scalp, auricle, facial soft tissue, orbital, oral cavity, nasopharyngeal, and skull base defects. Moreover, the flap may be harvested with the overlying scalp, making it particularly useful for defects of the hair-bearing regions. Additionally, if more substantial reconstruction is required, the TPFF may be elevated in a combined or chimeric fashion with temporalis muscle and/or adjacent calvarial bone. When harvested for free microvascular anastomosis, the TPFF can be useful for a wide array of distal extremity reconstructions, specifically the hand and feet.
In order to increase the success of harvesting the temporoparietal fascia flap, it remains paramount to understand the relevant anatomy.
Layers (from superficial to deep) potentially encountered during harvesting of the TPFF include:
The temporoparietal fascia represents a thin layer of connective tissue, which lies below the level of the subcutaneous adipose tissue. The TPFF lies in continuity with the adjacent galea aponeurosis, which exists beyond the temporal line.
NOTE: Dissection along the anterior/frontal branch of the STA may put the frontotemporal branch of the facial nerve at risk. Various anatomic landmarks can be used to help identify the course and/or location of this nerve, including:
The temporoparietal fascia flap is a well-recognized technique in head and neck, hand, and lower extremity reconstruction. It can be harvested as a pedicled flap, chimeric flap (alongside the deep temporal fascia with/without the inclusion of surrounding calvarial bone), or as a free tissue flap, depending on the size and thickness of the defect needing to be repaired. Without a doubt, however, the thin nature of the TPFF renders it a great choice for reconstruction of a variety of defects involving the skull base, facial soft tissues, nasopharynx, oral cavity, orbit, ear, and scalp.
There are few contraindications to consider when performing a temporoparietal fascia flap:
It is not necessary to shave any hair during this procedure, though it may be helpful to shave the hair 1 to 2 cm beyond the anticipated incision line.
Potential complications for a temporoparietal fascia flap may include:
The majority of complications can be avoided with meticulous dissection and careful flap elevation respecting the local scalp anatomy. Rates of flap loss (partial vs. total) are roughly 2.44%. Some degree of alopecia may be documented in up to 8% of patients. Injury to the frontotemporal branch of the facial nerve resulting in transient weakness to paralysis may range from 1% to 20%.
A temporoparietal fascia flap can act as a work-horse reconstructive option in the armamentarium of a reconstructive surgeon. It is a low-risk option for the reconstruction of local (craniofacial) and distal soft tissue defects. It has found notoriety in head and neck reconstruction as a pedicled flap but may be harvested as a free flap for extremity reconstruction. In the hands of an experienced and knowledgeable surgeon, the outcomes can be very satisfactory.
It remains imperative to identify the risk factors and perform a thorough assessment before performing a temporoparietal fascial flap. The patient should have the following done:
An interprofessional team of an experienced surgeon, anesthesiologist, surgical assistant, and operative nurse should perform the temporoparietal fascial flap for best outcomes. Close follow-up should monitor the patient for potential complications: flap necrosis, alopecia, wound breakdown, hematoma, and facial paralysis. Proper education should counsel the patient on appropriate wound care and activity level.
This coordinated interprofessional care is essential to achieving the best results in reconstructive procedures utilizing a temporoparietal fascial flap. [Level 5]
Recovery following a temporoparietal fascia flap depends on the complexity of the original problem for which the reconstruction was performed. Local wound care is paramount to ensure a healthy and clean surgical environment. Suction drains (if placed) can be removed when output has appropriately decreased (e.g., output less than 30 mL over 24 hours). The patient should avoid rigorous activity for the next 10 days following surgery to allow adequate wound healing. Following discharge, the patient is typically followed regularly for several weeks to months to ensure proper healing.
Close follow-up should monitor for potential possible complications: flap necrosis, alopecia, wound breakdown, hematoma, and facial paralysis. The ancillary staff should assist in patient education, monitoring, and follow-up coordination.
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