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The Temporoparietal Fascial Flap Is an Alternative to Free Flaps for Orbitomaxillary Reconstruction

Kim, John Y. S. M.D.; Buck, Donald W. II M.D.; Johnson, Sarah A. B.S.; Butler, Charles E. M.D.

Plastic and Reconstructive Surgery: September 2010 - Volume 126 - Issue 3 - p 880-888
doi: 10.1097/PRS.0b013e3181e3b6f0
Reconstructive: Head and Neck: Original Articles

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.

Conclusion: 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.

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.

Received for publication January 5, 2010; accepted March 5, 2010.

Charles E. Butler, M.D., Department of Plastic Surgery, Unit 443, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, cbutler@mdanderson.org

Disclosure: No external support was received for this study. The authors have no conflicts of interest regarding this research.

©2010American Society of Plastic Surgeons