The temporoparietal fascial flap in reconstruction of the cranio-maxillofacial area.

An improved understanding of the vascular supply of the layers of the temporal fossa has increased the potentiality of reconstructive techniques involving this area. Each separate vascularized layer of this region can be used, yet the temporoparietal fascial flap is the more useful for treating a wide range of composite defects. It represents an ultra thin coverage which is useful in resurfacing exposed bone, tendons and vital structures such as nerves and vessels, in providing neovascularity as a recipient graft bed and in providing coverage or lining in major facial reconstructions. We describe our experience with the temporoparietal fascial flap which represents our choice for reconstructing composite defects in orbital, malar, auricular and cheek areas when what is required is a thin, pliable, well vascularized flap to carry a scalp or skin graft, to resurface exposed cartilage, bone and nerve, and to fill soft tissue contour defects. Illustrative cases from the authors' clinical experience are presented, to demonstrate various combinations of the temporoparietal fascial pedicle with other tissues in the reconstruction of the ear, eyebrows, eyelids, malar, cheek and parotid areas.