Selection of Superficial Temporal Artery Flaps for Eyebrow Reconstruction: Two Illustrative Cases.

BACKGROUND

Eyebrow reconstruction remains challenging because an optimal outcome depends on restoring both stable soft-tissue coverage and natural hair-bearing characteristics. Several options are available, including hair transplantation, hair-bearing grafts, local flaps, and hair-bearing fascio-cutaneous flaps based on the superficial temporal artery (STA). Recipient-site and defect characteristics, together with patient factors, guide whether an STA-based flap is indicated. Once an STA flap has been chosen, however, the decision between a pedicled and a free transfer is determined primarily by donor-site availability, namely the condition of the ipsilateral temporal region and its vessels. Explicit decision-making criteria for this two-step reasoning are not well defined.

CASES PRESENTATION: We present two cases that illustrate flap selection rather than a comparison of techniques. In the first case, a pedicled STA flap was used to reconstruct a partial eyebrow defect when the ipsilateral temporal region was intact. In the second case, previously reported elsewhere, a contralateral free STA flap was used for total eyebrow reconstruction because the ipsilateral temporal region had been compromised by prior surgery.

RESULTS

Both flaps survived completely without major complications. At long-term follow-up, both reconstructions showed restoration of the eyebrow contour with acceptable symmetry, hair direction, and density relative to the contralateral side, and high patient satisfaction.

CONCLUSION

STA fascio-cutaneous flaps are a reliable option for eyebrow reconstruction. When an STA-based flap is indicated, the choice between a pedicled and a free transfer is governed mainly by donor-site availability: a pedicled flap when the ipsilateral temporal region is preserved, and a free flap when it is unavailable. These cautious, case-based observations are intended to illustrate clinical reasoning rather than to establish the superiority of one technique.