Dermatologic surgeons may encounter challenging defects of the head and neck that are not amenable to repair with local flaps or grafts.
We offer a comprehensive review of the temporoparietal fascia flap (TPFF) and provide a step-by-step illustration of its application performed under local anesthesia for a challenging reconstructive scenario.
A 66-year-old male initially underwent Mohs micrographic surgery resulting in a large full-thickness defect at the postauricular scalp contiguous with a through-and-through defect of the upper right ear. A TPFF was performed under local anesthesia to reconstruct the surgical defect.
Complete healing in our patient was noted at 10 weeks after completion of the TPFF. However, granulation caused adherence of the ear to the postauricular scalp, which was corrected by a dividing incision to release the ear. At 4 weeks after the division, lateral projection of the ears was symmetric and readherence of the ear did not recur.
The TPFF is a highly versatile pedicled flap that can be performed under local anesthesia to reconstruct a variety of complex defects on the head and neck. This case reveals that the TPFF adds a powerful tool to the armamentarium of dermatologic surgeons.
*Department of Dermatology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland;
†Department of Dermatology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
Address correspondence and reprint requests to: Jeremy S. Bordeaux, MD, MPH, 11100 Euclid Avenue, Lakeside 3500, Cleveland, Ohio 44106, or e-mail: firstname.lastname@example.org
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