The reverse superficial temporal artery flap from the preauricular region, for the small facial defects

Construction and study of a three-dimensional visualization model of superficial temporal artery branches: With an explicatory case

BACKGROUND

The anatomical parameters of the superficial temporal artery branches were measured by a three-dimensional measurement method to provide anatomical reference for relevant clinical operations.

METHODS

Seventy original images were selected who had cranial CTA examination. The patients were aged 30-79 years, with an average of 60.0 years, including 32 females and 38 males. After reconstructing the superficial temporal artery by professional medical 3D reconstruction software, its anatomical parameters were measured.

RESULTS

The length of the secondary branches of the frontal branch of the superficial temporal artery were 47.6 ± 23.6 mm and 37.3 ± 21.6 mm in males and females, respectively, with a statistically significant difference. The length of the secondary branches of the parietal branch of the superficial temporal artery were 39.6 ± 20.4 mm and 49.2 ± 20.3 mm in young and middle-aged people and older people respectively, which were statistically different. The remaining measures were not statistically different across gender and age groups. The frontal branch of the superficial temporal artery was divided into three types, and the parietal branch of the superficial temporal artery was divided into two types.

CONCLUSIONS

The anatomical parameters of the superficial temporal artery branches can be accurately measured by means of 3D visualization, providing an anatomical reference for relevant clinical operations.

Improved Reverse Postauricular Island Flap for Repair of Lower Conjunctival Fornix Retraction

ABSTRACT

Repair of lower conjunctival fornix retraction is a great challenge for plastic surgeons in the aspects of orbital prosthesis retaining and cosmetic appearance. Hereby, a 25-year-old woman, suffering from lower conjunctival fornix retraction after the removal of retinoblastoma and radiotherapy, was undertaking the treatment with an improved reverse postauricular island flap for expansion of the lower conjunctival fornix, and volume augmentation of the anophthalmic socket in one stage. The flap was based on the parietal branch of the superficial temporal artery and its vascular architecture to the postauricular vascular system, and successfully transferred by passing through a subcutaneous tunnel. The satisfactory result indicated that the mentioned technique may be a good option in surgical rehabilitation of the stable depth of the lower conjunctival fornix, not only from the reliable blood supply and the suitable thickness of the flap but also from the less donor morbidity without an exposed unsightly scar.

LEVEL OF EVIDENCE

Level V.

The application of a retrograde postauricular island flap in reconstructing periorbital region defects

BACKGROUND

Reconstruction of periorbital region defects is thought to be one of the most challenging areas in reconstructive plastic surgery. This paper describes our experiences with the application of retrograde postauricular island flaps in reconstructing periorbital region defects.

METHODS

Between November 2008 and June 2019, 16 patients with periorbital region defects underwent treatment using a retrograde postauricular island flap. The flap is designed with two portions: 1) the pedicle segment only with the superficial temporal fascia and 2) the flap segment in the posterior auricular region with non-hair-bearing full-thickness tissue. Intraoperatively, the vascular networks between the postauricular and the superficial temporal vessels were preserved. The flap was then transferred to the receipt area after passing through a subcutaneous tunnel. The donor site was directly closed in the postauricular sulcus by advancing the posterior scalp flap.

RESULTS

All the periorbital region defects were reconstructed in one-stage surgery. All the flaps survived without venous congestion. The size of the harvested flaps varied from 5.0 × 2.5 cm to 7.5 × 5 cm. The colour of the transferred flaps matched the surroundings of the receipt region, and the eyelids functioned well.

CONCLUSION

A retrograde postauricular island flap is a good choice for the reconstruction of periorbital region defects. The flap can be useful for the reconstruction of the periorbital region, since it uses similar colours and textures. In addition, it permits a "one-stage" reconstruction with less conspicuous donor site scars behind the auricle.

Full-thickness total upper eyelid reconstruction with a lid switch flap and a reverse superficial temporal artery flap

BACKGROUND

Reconstruction of the upper eyelid with the same eyelid tissue is desirable because of the ability to achieve eye opening/closing and corneal protection, and a lid switch flap is a useful method. For total defects, almost all of the tissues of the lower eyelid should be used; however, the reconstruction of the lower eyelid donor site has often been undervalued. Reconstruction with an insufficient amount of soft tissue often results in complications such as lagophthalmos and ectropion. Here, we report our method of management of total upper eyelid defects and secondary reconstruction of the lower eyelid donor site.

METHOD

A lid switch flap is designed on the lower eyelid as the first operation. As important points, the height of the flap of the anterior lamina should be the same but the conjunctiva as the posterior lamina should be harvested up to the conjunctival fornix to obtain sufficient tissue. After switching the flap, the lower eyelid donor site is reconstructed with sufficient tissue: cheek mucosa, conchal cartilage, and a reverse superficial temporal artery flap as a three-layered structure.

RESULTS

Three patients were treated using our method, and we achieved favorable results with a sufficient amount of soft tissue for the reconstruction of the lower eyelid.

CONCLUSION

Reconstruction of the upper eyelid with sufficient tissue from the lower eyelid is important for eyelid function.

Reconstruction of a scalp defect due to cochlear implant device extrusion using a temporoparietal fascia flap and a split-thickness skin graft from the scalp

Cochlear implant extrusion, which is a common complication of cochlear implants, is generally repaired by a well visualized soft-tissue flap. A 61-year-old female patient with a medical history of schizophrenia who had a skin ulcer that caused cochlear implant extrusion, but that would be a stronger statement was referred to our department for removal of the implant and reconstruction of the resultant scalp defect. Accordingly, the broad defect was covered via rotation of a temporoparietal fascia flap (TPFF) using the superficial temporal artery, with the pedicle in the preauricular region as the pivot point. Coverage of TPFF was achieved with a split-thickness skin graft using the scalp as the donor site, which led to a quick recovery after the operation and satisfactory results in terms of aesthetics. This case suggests that a TPFF might be used as a flexible flap with low donor site morbidity for reconstructing cases of cochlear implant extrusion accompanied by a large full-layer scalp defect.

The Superficial Temporal Artery: Anatomical Map for Facial Reconstruction and Aesthetic Procedures

BACKGROUND

The superficial temporal artery (STA), a terminal branch of the external carotid artery, supplies multiple regions of the scalp and face. Knowledge of the STA is important for reconstructive and aesthetic procedures of the head and face.

OBJECTIVES

The aim of this study was to map the STA in relation to anatomical landmarks.

METHODS

Computed tomographic head angiographies of 215 patients were included in this study; the final analysis comprised 419 STAs. The STA's main branches and variants were identified. The diameters of the STA and its frontal and occipital branches were measured, and the distance between the STA tree and anatomical landmarks was delineated.

RESULTS

Frontal and parietal branches were recorded in 98.1% and 90.7% of patients, respectively. The mean diameters, measured 1 and 7 cm from the STA bifurcation for the frontal branch, were 0.97 ± 0.32 and 0.81 ± 0.26 mm, respectively, and for the parietal branch, the diameters were 0.96 ± 0.28 and 0.76 ± 0.23 mm, respectively. The STA bifurcation point was located above the zygomatic arch (ZA) in 75.6%, below in 14.7%, and on the ZA in 9.7% of patients. The mean distance from the ZA center to the STA bifurcation was 16.8 ± 16.0 mm.

CONCLUSIONS

The STA artery and its main branches follow a conservative course, and serious anatomical variations are relatively rare. The STA and its main branches may be localized using simple anatomical landmarks. An anatomical map showing artery-free zones in the lateral forehead region was presented, which may prove useful for plastic, reconstructive, and aesthetic surgeons.

Level of Evidence: 4.

Using the Reversed Temporal Island Flap to Cover Small Forehead Defects from Titanium Mesh Exposure After Cranial Reconstruction

BACKGROUND

Skin ulcers and alloplastic implant exposure are intractable complications that arise after cranial defect reconstruction. Many methods have been used to repair these defects, including skin grafting, local flaps, and free flaps; however, in most cases, alloplastic implants must be removed to control infections. Here, we describe the use of a reversed temporal island flap to repair exposed titanium mesh without removing it.

METHODS

Eight cases of skin and titanium mesh exposure were included from 2010 to 2015. A preauricular flap pedicled on the reversed superficial temporal artery was designed to repair forehead defects. The titanium mesh was retained, resterilized, and reimplanted.

RESULTS

Flaps were survived completely, and the titanium meshes were reimplanted with no complications. The results were aesthetically and functionally sufficient, with minimal donor-site morbidity in all cases during the 10- to 24-month follow-up period.

CONCLUSIONS

The described method is easy to design and perform. The flap has a reliable blood supply to help fight infection. The titanium mesh is preserved completely, avoiding a second cranioplasty.

The Infraorbital Artery in Fetuses: Clinical Relevance in Perforator Flap Surgery

Introduction:

The reconstruction of soft tissue detects in mid facial region are highly demanding. Most challenging region are nasal alla. For full thickness nasal alla defects most authors use nasolabial flap based on facial/angular arcade, but for recidivans tumors the infraorbital perforator flap is a good solution.

Aim:

The aim of our research was to analyze the number and the course of the infraorbital artery terminal branches.

Material and methods:

Material was 60 fetal hemifacial specimens of different gestational ages. Fetuses were fixed in 10% formalin and arterial blood vessels were injected with Micropaque solution (barium sulfate). Samples were further processed by Spalteholz technique, their images captured with digital camera and analyzed. Infraorbital artery was constant artery and had 2 to 4 terminal branches supplying infraorbital region. The majority of its terminal branches were characterized with descending course. Reach anatomical network of infraorbital artery made anastomoses with facial artery.

Conclusion:

Perforator flap based on infraorbital artery had well defined vascular supply with numerous soft tissue branches, which qualify this flap as safe solution for nasal reconstruction.

Reconstruction of periorbital soft tissue defect with reversed superficial temporal artery island flap

BACKGROUND

Periorbital soft tissue reconstruction is a challenge because of its difficulty in regaining both the form and the function. Local flap is the priority method because it could provide excellent match in skin color and texture.

OBJECTIVE

We aim to investigate the application of pedicled reversed superficial temporal artery island flap in the reconstruction of periorbital soft tissue defect.

METHOD

Different kinds of reversed superficial temporal artery island flaps were harvested from the auricular area to cover the defect in the periorbital area.

RESULTS

Ten patients who suffered congenital or acquired periorbital diseases were treated with this method. One case suffered minor venous congestion postoperatively. All the other cases achieved good aesthetic result in both the donor and the recipient sites.

CONCLUSION

Reversed superficial temporary artery island flap could be safely harvested from the auricular region even in a split pattern. It could be used to cover the periorbital defect with an unconscious scar at the donor site.

Columella lengthening by a vascularized preauricular flap

BACKGROUND

A short columella can result in significant cosmetic and functional deformities. Various techniques such as local flap transfer and composite grafts have been reported for columellar lengthening, but the overall results remain unsatisfactory. Transferring a local flap cannot provide new tissue for the columella, which limits its application. Composite grafting can provide new tissue volume, and the composite tissue from the preauricular region has an excellent color and texture match. However, the lack of a stable blood supply for the composite graft restricts its clinical application due to problems such as viability, dimensions, and atrophy. To overcome these limitations, the authors harvested a vascularized preauricular flap for columella lengthening.

METHODS

Based on the superficial temporal vessels, the vascularized preauricular flap was harvested as a free flap and transferred to the columella region. The recipient vessels were angular vessels or facial vessels, and microsurgical anastomosis was performed between recipient vessels and the pedicle. The lateral femoral circumflex vessels were used as vascular grafts when the pedicle was not long enough.

RESULTS

Eight patients who had short columellas were reconstructed with vascularized preauricular flaps. Six flaps were harvested in a reverse fashion, and the remaining two flaps were harvested in an anterograde direction. All the flaps survived well and showed a good color and texture match without hypertrophic scars. An average of 13.3 mm improvement in length was obtained for the eight patients. Two patients underwent a secondary debulking procedure to thin the flap.

CONCLUSION

The free vascularized preauricular flap procedure is a reliable method for columellar lengthening and has wide clinical application.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Scalp reconstruction with superficial temporal artery island flap: clinical experience on 30 consecutive cases

BACKGROUND

Different techniques are available to reconstruct scalp defects; however, when the cranium is exposed or the hairline compromised, the procedure may become quite challenging. The use of superficial temporal artery fascio-cutaneous flaps has been described mainly to restore the hair-bearing surface of the upper lip or the eyebrow but only few applications in the scalp have been reported. The authors present their experience with the use of superficial temporal artery island flaps to obtain durable coverage and excellent contour in anterior scalp reconstruction.

METHODS

Thirty consecutive defects in the anterior scalp subunits (temporal = 14; parietal = 12; forehead = 4) were reconstructed with ipsilateral V-Y island flaps nourished by frontal and parietal branches of the superficial temporal artery. All defects resulted from skin cancer excision. Twenty-six flaps were based on the parietal branch. The frontal branch pedicle was used in only four cases to resurface defects in the forehead subunit. Glabrous skin flaps were harvested in six patients. Including a venous branch in the pedicle was not mandatory because the venous drainage of the flaps was provided by the perivascular fascial network. For this reason, a fascial pedicle around the artery, 2-3 cm in width, was maintained to minimise flap venous insufficiency.

RESULTS

Twenty-nine flaps healed uneventfully (96.7% flap survival rate), providing stable coverage with a mean follow-up of 12 months. In the early postoperative time (up to 48 h), slight venous stasis was observed in 14 flaps (46.6%), but it resolved spontaneously within 1 week. Two flaps showed severe venous stasis, but in only one case (3.3%) it progressed to distal necrosis requiring surgical revision. No cases of alopecia or hairline distortion were postoperatively registered.

CONCLUSIONS

The use of superficial temporal artery island flaps, mobilised in a V-Y fashion, proved to be an elegant and reliable solution to resurface defects in the anterior scalp subunits in both hairy and bald patients.