The temporoparietal fascial flap is an alternative to free flaps for orbitomaxillary reconstruction.
BACKGROUND
The temporoparietal fascial flap is a thin, pliable, well-vascularized, locoregional flap that can be a reasonable alternative to traditional free flap reconstruction, but its utility for reconstruction of orbitomaxillary defects is often overlooked. The authors investigated the rationale for and benefits of the use of this flap over free tissue transfer in a well-defined subset of head and neck cancer cases.


METHODS
The records of all patients who underwent temporoparietal fascial reconstruction for orbitomaxillectomy between 1993 and 2008 were reviewed. Demographic data, preoperative plans, operative details, and outcomes were assessed to (1) determine the overall outcomes for the temporoparietal fascial flap and (2) analyze preoperative and intraoperative factors that led to the choice of this flap instead of the originally planned free flap.


RESULTS
Nineteen patients (mean age, 56 years) were included in this study. Ten (53 percent) were initially considered for free flap reconstruction. Among them, the principal reasons for electing the temporoparietal fascial flap were (1) smaller-than-anticipated extent of resection, (2) need for coverage of implant or bone or thin prosthesis support, and (3) patient comorbidities. Nine resections (47 percent) involved the orbit alone, two (11 percent) involved the maxilla alone, and eight (42 percent) involved a combination of the two. Five patients (26 percent) received neoadjuvant radiation. Four (21 percent) experienced complications (flap failure, ectropion, enophthalmos with intraoral mesh extrusion, and partial skin graft loss). Mean follow-up time was 36 +/- 27 months.


CONCLUSIONS
The temporoparietal fascial flap is a viable alternative to free flaps for orbitomaxillary defects when orbital resection is limited, when obturator reconstruction is desired, or when comorbidities preclude microvascular surgery.
Kim
John Y S
JYS
Chicago, Ill.; and Houston, Texas From the Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, and the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center.
Buck
Donald W
DW
Johnson
Sarah A
SA
Butler
Charles E
CE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005153:Facial Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008441:Maxillary Neoplasms / Q000601:surgery*; D008875:Middle Aged; D009918:Orbital Neoplasms / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D055815:Young Adult
Cheney ML, Megerian CA, Brown MT, et al. The use of the temporoparietal fascial flap in temporal bone reconstruction. Am J Otol. 1996;17:137–142.
Cheney ML, Varvares MA, Nadol JB Jr. The temporoparietal fascial flap in head and neck reconstruction. Arch Otolaryngol Head Neck Surg. 1993;119:618–623.
Matsuba HM, Hakki AR, Romm S, et al. Variations on the temporoparietal fascial flap. Laryngoscope 1990;100:1236–1240.
Panje WR, Morris MR. The temporoparietal fascia flap in head and neck reconstruction. Ear Nose Throat J. 1991;70:311–317.
Raffaini M, Costa P. The temporoparietal fascial flap in reconstruction of the cranio-maxillofacial area. J Craniomaxillofac Surg. 1994;22:261–267.
Abul-Hassan HS, Von Drasek AG, Acland RD. Surgical anatomy and blood supply of the fascial layers of the temporal region. Plast Reconstr Surg. 1986;77:17–28.
Brent B, Upton J, Acland RD, et al. Experience with the temporoparietal fascial free flap. Plast Reconstr Surg. 1985;76:177–188.
Horowitz JH, Persing JA, Nichter LS, et al. Galeal-pericranial flaps in head and neck reconstruction: Anatomy and application. Am J Surg. 1984;148:489–497.
Tellioglu AT, Tekdemir I, Erdemli EA, et al. Temporoparietal fascia: An anatomic and histologic reinvestigation with new potential clinical applications. Plast Reconstr Surg. 2000;105:40–45.
Strauch B, Yu HL, Chen ZW. Atlas of microvascular surgery: Anatomy and operative approaches. In: The Temporoparietal Fascia Flap. New York: Thieme; 1993:528–535.
Mehrara BJ, McCarthy JG. Repair and grafting of bone. In: Mathes SJ, ed. Plastic Surgery. Vol. 1. Philadelphia: Elsevier; 2006:639–718.
Bite U, Jackson IT, Wahner HW, et al. Vascularized skull bone grafts in craniofacial surgery. Ann Plast Surg. 1987;19:3–15.
McCarthy JG, Zide BM. The spectrum of calvarial bone grafting: Introduction of the vascularized calvarial bone flap. Plast Reconstr Surg. 1984;74:10–18.
Psillakis JM, Grotting JC, Casanova R, et al. Vascularized outer-table calvarial bone flaps. Plast Reconstr Surg. 1986;78:309–317.
Rose EH, Norris MS. The versatile temporoparietal fascial flap: Adaptability to a variety of composite defects. Plast Reconstr Surg. 1990;85:224–232.
Lai A, Cheney ML. Temporoparietal fascial flap in orbital reconstruction. Arch Facial Plast Surg. 2000;2:196–201.
Atabay K, Atabay C, Yavuzer R, et al. One-stage reconstruction of eye socket and eyelids in orbital exenteration patients. Plast Reconstr Surg. 1998;101:1463–1470.
Futran ND. Primary reconstruction of the maxilla following maxillectomy with or without sacrifice of the orbit. J Oral Maxillofac Surg. 2005;63:1765–1769.
Yucel A, Cinar C, Aydin Y, et al. Malignant tumors requiring maxillectomy. J Craniofac Surg. 2000;11:418–429.
Santamaria E, Cordeiro PG. Reconstruction of maxillectomy and midfacial defects with free tissue transfer. J Surg Oncol. 2006;94:522–531.
Stavrianos SD, Camilleri IG, McLean NR, et al. Malignant tumours of the maxillary complex: An 18-year review. Br J Plast Surg. 1998;51:584–588.
Peng X, Mao C, Yu GY, et al. Maxillary reconstruction with the free fibula flap. Plast Reconstr Surg. 2005;115:1562–1569.
Sukkar SM, Daw JA, Chandler J, Dumanian GA. Gracilis muscle free flap transfer using a radial artery/venae comitantes composite vascular pedicle. Plast Reconstr Surg. 2001;108:156–161.
Nakayama B, Matsuura H, Hasegawa Y, et al. New reconstruction for total maxillectomy defect with a fibula osteocutaneous free flap. Br J Plast Surg. 1994;47:247–249.
Chepeha DB, Moyer JS, Bradford CR, et al. Osseocutaneous radial forearm free tissue transfer for repair of complex midfacial defects. Arch Otolaryngol Head Neck Surg. 2005;131:513–517.
Chang DW, Langstein HN. Use of the free fibula flap for restoration of orbital support and midfacial projection following maxillectomy. J Reconstr Surg. 2003;19:147–152.
Hashikawa K, Tahara S, Ishida H, et al. Simple reconstruction with titanium mesh and radial forearm flap after globe-sparing total maxillectomy: A 5-year follow-up study. Plast Reconstr Surg. 2006; 117:963–967.
Villaret DB, Futran NA. The indications and outcomes in the use of osteocutaneous radial forearm free flap. Head Neck 2003;25:475–481.
Brown JS. Deep circumflex iliac artery free flap with internal oblique muscle as a new method of immediate reconstruction of maxillectomy defect. Head Neck 1996;18:412–421.
Maranzano M, Atzei A. The versatility of vascularized iliac crest with internal oblique muscle flap for composite upper maxillary reconstruction. Microsurgery 2007;27:37–42.
Butler CE, Lewin JS. Reconstruction of large composite oromandibulomaxillary defects with free vertical rectus abdominis myocutaneous flaps. Plast Reconstr Surg. 2004;113:499–507.
Cinar C, Arslan H, Ogur S, et al. Free rectus abdominis myocutaneous flap with anterior rectus sheath to provide the orbital support in globe-sparing total maxillectomy. J Craniofac Surg. 2006;17:986–991.
Pryor SG, Moore EJ, Kasperbauer JL. Orbital exenteration reconstruction with rectus abdominis microvascular free flap. Laryngoscope 2005;115:1912–1916.
Hanasono MM, Lee JC, Yang JS, et al. An algorithmic approach to reconstructive surgery and prosthetic rehabilitation after orbital exenteration. Plast Reconstr Surg. 2009;123:98–105.
Cordeiro PG, Santamaria E. A classification system and algorithm for reconstruction of maxillectomy and midfacial defects. Plast Reconstr Surg. 2000;105:2331–2346.
Triana RJ, Uglesic V, Virag M, et al. Microvascular free flap reconstruction options in patients with partial and total maxillectomy defects. Arch Facial Plast Surg. 2000;2:91–101.