Fan Flap of Parietotemporal Fascia

The head is shaved on the designated side. A Doppler probe is used to locate and mark the course of the superficial temporal artery (Fig. 10.32a), and the skin over the fascia is opened with a zigzag incision (Fig. 10.32b). The skin should not be incised too deeply, because the parietotemporal fascia directly overlies the deep temporal fascia and is just below the hair bulbs and fat. The scalp is dissected to the left and right, directly below the plane of the hair bulbs. At this point the blood vessels can be clearly traced upward from the preauricular area. A fascial flap is outlined based on the size and shape of the auricular framework, which has already been fabricated. The flap is dissected from the deep temporal fascia and turned downward on its vascular pedicle (Fig. 10.32c). The cutaneous wound is closed in layers over a vacuum suction drain, and the auricular framework is covered with the fascia (Fig. 10.32d). Next a split-thickness or full-thickness skin graft is obtained and attached to the fascia with fibrin glue and a few interrupted sutures. The suction drain will coapt the fan flap to the auricular framework (Fig. 10.32d). A Vaseline pack is applied and secured with tape (for 1 week) to help shape and protect the reconstruction. Further touch-ups are added later as required (see second stage pp.33; Fig. 10.31). Transient flap edema is normal initially, but the flap should assume the desired shape and thickness over a period of weeks.

Temporal Flap

Fig. 10.32 Parietotemporal fascia transferred as a fan flap. a The superficial temporal artery and vein are identified (with Doppler ultrasound). b The parietotemporal fascia and blood vessels are exposed through a zigzag incision. (GE = cartilage framework)

c The parietotemporal fascia is raised on a vascular pedicle. d The cartilage framework is covered with the vascularized fascia, followed by thick split skin (see text), and all wounds are closed.

Fig. 10.33a, b Large defect in the auricular region repaired with an inferiorly based rotation flap.

Fig. 10.33a, b Large defect in the auricular region repaired with an inferiorly based rotation flap.

Was this article helpful?

0 0
How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

Get My Free Ebook


Post a comment