Venous Congestion in Pedicled Frontal Branch Superficial Temporal Artery Flaps Reconstructions for Head and Neck Defects: A Review

Superficial Temporal Artery Posterior Branch Flap for Reconstruction of Composite Oral/Perioral Defects

PURPOSE

Defects involving total lower and/or upper lip often extend to intraoral and/or perioral areas. Flaps based on superficial temporal artery, either as pedicled or free flaps, can be used for reconstruction of various head and neck defects. In this clinical study, we tried to demonstrate the application of a pedicled flap based on the posterior branch of superficial temporal artery in 3-dimensional reconstruction of these composite oral/perioral defects as a successful alternative in cases where microvascular tissue transfer cannot be performed.

PATIENTS AND METHODS

Six male patients with composite perioral/oral defects who underwent reconstruction with a pedicled flap based on the posterior branch of the superficial temporal artery between April 2020 and December 2020 were evaluated retrospectively. Demographic data, topographic data of defects, and the dimensions of the flaps were gathered from patient files. All patients required reconstruction after tumor resection.

RESULTS

All flaps survived without any signs of partial or total necrosis. Postoperatively, the patients did not report any oral incompetence or drooling, and they were able to fully close their mouths.

CONCLUSIONS

Pedicled flaps based on the posterior branch of superficial temporal artery provide reliable results in composite perioral/oral reconstruction.

Reconstruction of Large Cervicofacial Defects With Expanded Island Superficial Temporal Artery Flaps and an 810-nm Diode Laser Hair Removal Technique

BACKGROUND

Extensive cervicofacial reconstruction is challenging for plastic surgeons. Because of the location of the adjacent scalp flap nourished by the superficial temporal artery (STA), it can be a candidate for cervicofacial reconstruction.

OBJECTIVES

This article aims to report a combined treatment of an expanded island STA flap and an 810-nm diode laser hair removal technique for extensive cervicofacial defects.

METHODS

Between January 2015 and December 2018, 10 patients with lower face and neck scar contraction were reconstructed with a bilateral or unilateral expanded STA island flap and an 810-nm diode laser for hair removal in this retrospective study. Hair removal via the 810-nm laser was started when the injected volume reached the volume of the expander, with a fluence of 35 to 40 J/cm2 and a 1 to 2 Hz repetition rate. Before second-stage surgery, the hair reduction rate was assessed. Twelve months after surgery, the degree of epilation efficacy according to the satisfaction scale and Global Aesthetic Improvement Scale was evaluated.

RESULTS

This study included 2 single-pedicle flaps and 8 double-pedicle flaps. The average size of the implanted expanders was 600 mL. The average injected volume was 1405 mL. Before second surgery, there was a 67.4% hair reduction rate. Twelve months after surgery, the results of Global Aesthetic Improvement Scale were very good (3), good (6), average (1), and poor (0).

CONCLUSIONS

The expanded island STA flap and 810-nm diode laser technique may be a novel treatment option for severe face and neck aesthetic reconstruction.

Different Transfer Forms of the Expanded Forehead Flap Pedicled with Superficial Temporal Vessels to Treat Chin and Submental Scar Deformities

BACKGROUND

The chin and submental regions are located at the junction of the face and neck. Its function and aesthetic appearance can be seriously affected when scar deformities cause the cervicomental angle to disappear. The expanded forehead flap pedicled with superficial temporal vessel(s) is a surgical treatment for chin and submental scar deformities. Different transfer types have developed for this flap based on individual situations. At present, there is no unified treatment strategy for applying this forehead flap to treat different regions and ranges of chin and submental scar deformities.

METHODS

Ninety one cases were collected from patients with chin and submental scar deformities that were treated using the expanded forehead flap pedicled with superficial temporal vessels from January 2008 to December 2018. The authors divided the chin and submental scar deformities into 4 types according to different regions and ranges, and summarized flap survival and complications of 5 different transfer forms used to treat scars for creating feasible treatment strategies. We followed up 76 cases, investigating the satisfaction of appearance and texture of the flaps, improvement of neck movement, and scar recurrence.

RESULTS

Expanded forehead flaps were used to repair 91 cases of chin and submental scar deformities. According to the postoperative flap survival and complications of flap blood supply, the treatment strategies are as follows: Bilateral cutaneous and subcutaneous pedicled forehead flaps are applied to treat scars in bilaterally symmetrical large-scale scars in Zone LCL. Unilateral pedicled forehead flaps are applied to treat small-scale scars in Zone C and Zone L. Unilateral pedicled plus contralateral vascular anastomosis and unilateral pedicled plus contralateral super thin forehead flaps are applied to treat the moderate-scale scars of Zone LC. Mean follow-up period was 81 months (range 28-131), 93.4% (71/76) was satisfied with appearance and texture of the flaps, 97.4% (74/76) was satisfied with the improvement of neck movement, and 2.6% (2/76) occurred scar recurrence.

CONCLUSIONS

Five different types of expanded forehead flaps pedicled with superficial temporal vessels can be used to repair differential scar deformities of the chin and submental regions and achieve good therapeutic effects.

Use of Indocyanine Green Angiography to Identify the Superficial Temporal Artery and Vein in Forehead Flaps for Facial Reconstruction

ABSTRACT

The superficial temporal artery (STA) frontal branch flap is susceptible to venous congestion because of its unpredictable and variable outflow. The authors applied indocyanine green angiography in identifying the superficial temporal vessels to help surgeons with proper flap designs to avoid severe complications. A retrospective review from 2015 to 2020 was conducted. All the patients who underwent indocyanine green angiography before forehead flap transfer for facial defect reconstruction were reviewed. The STA and vein were observed using indocyanine green angiography preoperatively. The relationship between the artery and vein was investigated. The venous anatomy was analyzed to guide the pedicle design. The survival of the flap and complications were assessed. A total of 12 patients were identified and included in this study. Indocyanine green angiography allows clear visualization of the detailed anatomy of the STA and vein. The frontal branch of the vein had great variations and generally diverged from the arterial branch. The tiny venae comitantes provided sufficient drainage for 2 small forehead flaps. The frontal branch of the vein entered the forehead and was used as the outflow channel in 4 patients. The parietal branch of the vein, which consistently gave off secondary tributaries to the superior forehead, was included in the pedicle in 6 patients. All flaps survived without complications. Indocyanine green angiography provided accurate localization of the superficial temporal vessels. This technique may be helpful in the precise planning forehead flap surgeries and in avoiding the risk of venous congestion.

Aesthetic Design of Expanded Bilateral Superficial Temporal Vascular Fascial Pedicled Flap for Repairing Maxillocervical Scars

BACKGROUND

Large-scale maxillocervical scars impair face and neck function and damage appearance. The forehead expanded bilateral superficial temporal pedicled flap is a good treatment strategy for this area; however, the traditional cutaneous pedicled flap damages the temporal hair area. This impairs aesthetics and causes alopecia; furthermore, requires an additional pedicle-cut operation.

METHODS

A retrospective study was performed on 7 patients with large-scale maxillocervical scars from January 2014 to August 2018. Forehead expanders were implanted in the first-stage operation for all patients. After the injection and rest period, patients were treated using the forehead expanded bilateral superficial temporal vascular fascial pedicled flap. Superficial temporal vascular fascia pedicles were carefully harvested. The use of an intralesional or hidden retrotragus incision was determined by the presence of a preauricular scar. Patient satisfaction with postoperative neck activity and the incision scar was evaluated.

RESULTS

Intralesional and retrovagus incisions were used in 4 and 3 cases, respectively. One flap developed hematoma, which recovered completely after conservative treatment; all other cases had no complications. All flaps healed well. The neck mobility of the patients was significantly improved with no visible scar in the temporal region. Six cases reported being "very satisfied" and one was "relatively satisfied" with their improvement in neck mobility. All cases reported being "very satisfied" with frontotemporal morphology.

CONCLUSIONS

The forehead expanded bilateral superficial temporal vascular fascial pedicled flap is a good choice for patients with large-scale maxillocervical scars. This technique can maintain the aesthetics of temporal hair and reduce patients extra surgical injury.

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.

A thin superficial temporalis artery revealed by total necrosis of an island scalp flap, a case report

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Total necrosis of a scalp flap based on the STA is rare.

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Extensive exploration of the vascular supply of the scalp before pedicled flap is not a common rule.

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Impact of anatomic variations on scalp flap surgery is not well documented.

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Anatomical variation may impact negatively the outcome of single pedicled scalp flaps.

Introduction and importance

The superficial temporalis artery (STA) counts as one of the most reliable blood supplies capable of supporting the vascularization of the entire scalp. Therefore, total necrosis of a scalp flap based on the superficial temporalis artery is a rare complication.

Case presentation

A 43-year-old woman with a history of hypertension and cerebral stroke presented to our consultation for fronto-parietal scalp alopecia. The scar was the result of spontaneous healing of a chemical burn that occurred eight months earlier. We performed the first step of scalp expansion and raised a parietal expanded goblet island flap based on the right STA. In the postoperative period, the flap developed progressive necrosis. Despite the release of tension and stab incisions, the flap failed in a week. An angio-MRI revealed a thin STA on the right compared to the left side. After debridement, the necrosis was superficial, deep galea, and some subcutaneous tissues were viable. We performed a split-thickness skin graft that achieved a total wound closure.

Clinical discussion

An extensive exploration of the vascular supply of the scalp before raising a scalp flap is not a common rule. The anatomical variation that we discovered as a thin superficial temporal artery may have explained the total failure of this flap surgery.

Conclusion

Surgeons should keep in mind the possible existence of a detrimental anatomical variation when planning a single pedicled scalp flap.

Regional Salvage Flap Options in Head and Neck Reconstruction

Microvascular free tissue transfer is the standard in the complex head and neck reconstruction with success rates greater than 95%. Free tissue transfer allows for more versatility in reconstructing complex defects with better tissue match. Failures, however, do occur and subsequent free tissue transfer might not be an option due to either the patients' health or in a vessel depleted neck. In these challenging salvage scenarios, the head and neck reconstructive surgeon must turn to regional flaps for reconstruction. Here, we review multiple regional flap options for salvage head and neck reconstruction.

Pedicled Supraclavicular Flap for Neck Defect Reconstruction in Poland Syndrome

Introduction

The most accepted pathogenesis for Poland syndrome is the subclavian artery supply disruption sequence during embryonic growth. The result is associated with a constellation of abnormalities of structures supplied by the subclavian artery. We present a case of a neck defect reconstructed with a fasciocutaneous supraclavicular flap in a patient with Poland syndrome with the absence of a pectoralis major muscle. To the best of our knowledge, this is the first report of the use of the supraclavicular flap in patients with Poland syndrome.

Methods

An 80-year-old patient with a 14-mm-Breslow-thickness melanoma had undergone a 3-cm-wide local excision of the scar on his right neck and reconstruction with a pedicled supraclavicular flap despite him having Poland syndrome on the same side.

Results

The flap was well perfused, and the patient was discharged at postoperative day 5. Complete healing of the flap was observed without any flap loss.

Conclusion

The supraclavicular fasciocutaneous flap is a versatile and useful pedicled flap reconstruction for head and neck defects. It is possible in patients with Poland syndrome as shown, and the pedicle should be checked with preoperative Doppler and an exploratory incision before completely raising it.