Temporoparietal Fascial Flap

This flap can be used as a fascial or fasciocutaneous flap. The fascia covers the temporal muscle extending over the temporal fossa and lies superficial to the deep temporal fascia covering the temporalis muscle. It continues as the galea beyond the limits of the temporal fossa.

Vascular pedicle: Superficial Temporal Artery (STA) is the terminal branch of the carotid artery. The length of the artery is 4 cm and the diameter of the artery is 2 mm. The course of the vessels is on the fascia from the pre-auricular into the temporal fossa. The sensory nerve supply comes from the auriculotemporal nerve. The size of the flap is 12 x 9 cm2 (Fig. 8.6).31

Flap Harvesting

Preoperatively identify the course of the vessels with a Doppler probe and mark the incision lines parallel to hair follicles.

The patient position is supine with head slightly tilted to the opposite side. Start incision by raising a pretragal skin flap. The incision extends toward the vertex of the skull over the temporal fossa. Identify and spare the superficial temporal vein anterior and remain superficial to STA. Identify STA. Dissection proceeds cephaled deep to the hair follicles. Avoid damage to the superficial temporal vein. Avoid damaging the frontal branch of the facial nerve. After cephaled completion of the dissection incise flap. Lift from deep fascial plane towards auricle. Leave flap after complete dissection for observation of perfusion.

This flap is ideally suited for covering small defects of the foot, ankle, Achilles tendon and hand. The minimal thickness of this well-vascularized flap prompts some authors to describe the technique as a "microvascular transplantation of a recipient bed".32 This flap was found to be useful in cases of burns particularly when joint spaces or tendons are exposed after debridement.33


Fig. 8.6. Temporoparietal fascial flap Muscle Flaps

The following sections on each donor muscle flap include information on a. the muscles origin and insertion, function, vascular supply, innervation, and pedicle length;

b. the flaps (size, functional loss on removal, elevation): and c. any special problems that may be encountered in their use.

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