Double-Skin Paddled Superficial Temporofascial Flap for the Reconstruction of Full-Thickness Cheek Defect:

Superficial Temporal Artery Perforator Flap: Indications, Surgical Outcomes, and Donor Site Morbidity

The aim of this retrospective case series was to discuss indications, surgical outcomes, and donor site morbidity in the use of superficial temporal artery perforator (STAP) flaps in intra-oral or extra-oral facial reconstruction. This study involved 9 patients treated with a STAP flap at the Maxillo-Facial Surgery Unit of the University of Campania “Luigi Vanvitelli”, Naples. A STAP flap was used alone or in combination with other local flaps, for the coverage of facial soft tissue defects, after the resection of craniofacial malignant tumors (n = 7) or as a salvage flap, in partial or total microvascular flap loss (n = 2). The STAP flap was proven to be a valuable surgical option despite it not being frequently used in facial soft tissue reconstruction nor was it chosen as the first surgical option in patients under 70 year’s old. Donor site morbidity is one of the major reasons why this flap is uncommon. Appropriate patient selection, surgical plan, and post-surgical touch-ups should be performed in order to reduce donor site scar morbidity.

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

The superficial temporal artery (STA) flap is a versatile flap for head and neck defect reconstruction. It can be based on the frontal branch of the STA and an islanded 360-degree rotation arc for various defects on the scalp, cheek, and auricular region. It provides a nonmicrosurgical option for reconstructing such defects, which is itself relatively easy to perform. However, venous congestion is a problem than often can cause worry to the clinician and hence preclude its use. In this review, we revisit this flap in head and neck reconstruction, with case examples used for reconstruction of defects on the scalp, maxilla, lip, ear, and retroauricular area. The STA flap in our review can be used either as a fasciocutaneous flap or with its fascia alone. The main issue with the STA flap is that it is generally a high-inflow flap with variable outflow. Venous congestion is frequently encountered in our practice, and adequate management of the venous drainage in the postoperative period is crucial in ensuring its success as a versatile and viable option for head and neck reconstruction.

Reconstruction of Hair-Bearing Areas

Hair-bearing areas reconstruction is a difficult field because of limited donor area. Various techniques have been described for hair-bearing areas reconstruction, but the choice of the flap is variable depending on surgeons and patients. In this study, the authors present 7 patients who underwent soft tissue reconstruction with the pedicled superficial temporal artery-based flaps in the hair-bearing areas. No postoperative complications like bleeding, flap congestion, wound dehiscence, and flap necrosis were observed. This flap can be an alternative to the other methods because it is compatible with the face by the flap color and thickness, it can be easily harvested, it has a reliable circulation and minimum donor site scar.

Lower Face Reconstruction Using the Visor Flap

We present an alternative method instead of classical methods for lower face reconstruction in this study involving clinical experiences. We aimed to achieve more esthetic and functional results using visor flap. This flap has been used for the reconstruction of lower lip and submental region in two patients. Satisfactory functional and cosmetic outcomes were obtained in patients. Flaps and donor sides healed with no complications. The hair follicles on the flap continued to grow in new locations. The visor flap is a useful alternative method for lower face reconstruction. This technique offers perfect color and texture matching and hair growth.

Aesthetic considerations in flap reconstruction of the burnt face in males: A demonstrative case report

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A man presented with a deep burn of the right side of the face.

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Reconstruction was initially done with a latissimus dorsi free flap.

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The aesthetic outcome was poor.

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Salvage was done using a superficial temporal artery flap.

Introduction

The face is unique because functional and aesthetic considerations are equally important. Extensive deep chemical burns of the face are usually reconstructed with flaps. In males, the use of the hair – bearing superficial temporal artery flap has the advantage of achieving a satisfactory outcome with regards to both function and aesthetics.

Presentation of case

A 49-year-old man sustained a deep chemical burn to the right side of the face and neck. The resulting right peri-oral and neck contractures were initially reconstructed with a latissimus dorsi myo-cutaneous free flap. The functional outcome was satisfactory. The cosmetic outcome was poor and caused the patient to go into depression. Salvage was done using a hair-bearing superficial temporal artery flap.

Discussion

In males, the use of the hair-bearing superficial temporal artery flap in facial reconstruction respects the aesthetic units and is also able to achieve a satisfactory functional outcome.

Conclusion

We stress that aesthetic and functional considerations are equally important in facial reconstruction. In males, the hair-bearing superficial temporal artery flap is the flap of choice if the beard/moustache areas are involved.

Upper lip reconstruction using a pedicel superficial temporal artery flap

INTRODUCTION

The hair-bearing superficial temporal artery free flap has been used in men for total upper lip reconstruction. In this paper we present a case of a partial upper lip defect in a man that was reconstructed with a pedicle superficial temporal artery flap.

PRESENTATION OF CASE

Following a car accident, a 35-year old man sustained a partial upper defect. The defect included the entire "outer lamella" (i.e. the skin and red lip) of the right hemi-lip as well as the outer part of the muscle (i.e. partial defect of the middle lamella). A pedicle superficial temporal artery flap was raised and utilized to reconstruct the upper lip defect. There were no post-operative complications. The cosmetic and functional outcomes were excellent.

DISCUSSION

The hair-bearing pedicle superficial temporal artery flap is commonly used for eye-brow and beard reconstruction. Free superficial temporal artery flaps have also been utilized to reconstruct total upper lip defects. For the first time in the literature, our report introduces the use of the pedicle flap in partial upper lip defects.

CONCLUSION

We demonstrate that the pedicle flap is much simpler than the free flap and is adequate for reconstruction of partial upper lip defects. We also demonstrate a good cosmetic and functional outcome; and highlight several technical points to ensure a satisfactory outcome.

Double anterior (anterolateral and anteromedial) thigh flap for oral perforated defect reconstruction

OBJECTIVE

The purpose of this study was to assess the therapeutic efficacy of oral perforated defect reconstruction with a double anterior (anterolateral and anteromedial) thigh flap through the modified lateral lip-submandibular approach.

MATERIALS AND METHODS

From July 2010 to August 2013, eight patients with oral perforated defects secondary to oral cancer ablation involving the superior partial mandible or the posterior partial maxilla, with immediate reconstruction by double anterior (anterolateral and anteromedial) thigh flaps, were retrospectively enrolled into this study.

RESULTS

All double anterior flaps were musculocutaneous flaps. Seven double flaps resulted in good functional and aesthetic outcomes with complete flap survival. One patient required operative exploration in the postoperative period due to thrombosis in the external jugular vein. After the salvage, one of the double flaps in the intraoral region resulted in partial failure of the superficial skin of the flap. No functional impairment at the donor sites occurred in any of the cases.

CONCLUSION

The double anterior (anterolateral and anteromedial) thigh flap is a feasible and acceptable technique for reconstruction of an oral perforated defect involving the mandible or the maxilla through the modified lateral lip-submandibular approach. It presents a very acceptable aesthetic and functional result with the additional advantage of low morbidity at the donor site.

[Cheek reconstruction]

We describe the different cheek reconstruction techniques with primary emphasis on the superficial layers. In addition to the clinical context, location and size of the lesion will be taken into account to choose the best method that will optimize the functional and aesthetic results while minimizing potential sequelae. Main evaluation criteria include absence of natural orifice deformation, scar location, skin cover quality and respect of volumes.