Temporoparietal fascial flap in orbital reconstruction.
OBJECTIVE
To evaluate the success of the temporoparietal fascial flap (TPFF) in the primary or secondary reconstruction of difficult orbital defects and to review the surgical techniques.


METHODS
Retrospective analysis.


METHODS
Tertiary medical center.


METHODS
Nine patients with diverse orbital cavity or periorbital soft tissue and bony defects due to trauma, benign or malignant neoplasms, and radiation treatment.


METHODS
Temporoparietal fascial flap anatomy and techniques of harvest and inset are reviewed in detail. Four cases are presented to illustrate possible variables in orbital reconstruction. 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 possibility of concurrent osteointegrated implant placement with TPFF reconstruction.


METHODS
Functional and aesthetic outcomes were determined by physical examination and preoperative and postoperative photographs.


RESULTS
All patients had successful transfer of TPFF grafts without flap compromise. Temporoparietal fascial flap was a viable option for subtle orbital and malar contour defects. 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. The TPFF also supported the concurrent placement of a free calvarial bone graft. Finally, split-thickness skin grafted onto a pedicled TPFF showed 100% survival.


CONCLUSIONS
The TPFF is one of the most reliable and versatile regional flaps in the head and neck for orbital reconstruction. This study presents the use of TPFF in a variety of orbital defects, from lateral bony rim defects to total exenteration. Timing of repair in this study spans from immediate reconstruction to reconstruction delayed more than 50 years after the initial injury. In all cases, reconstruction with TPFF resulted in improved bony and soft tissue contours, and incurred minimal morbidity.
entmom@yahoo.com.
A
A
Lai
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ML
Cheney
D000328:Adult; D000368:Aged; D002280:Basal Cell Carcinoma / Q000601:surgery; D005151:Facial Injuries / Q000601:surgery*; D005260:Female; D006391:Hemangioma / Q000601:surgery; D006801:Humans; D008297:Male; D020273:Orbital Implants; D009918:Orbital Neoplasms / Q000601:surgery*; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps