Temporoparietal Fascia Free Flap for Nasoseptal Perforation Repair

Abstract

Nasoseptal perforations can be a challenging defect for the reconstructive surgeon, with repair limited by the surrounding tissue availability and the defect size. In patients with a history of cocaine use, often the integrity of surrounding vasculature is questionable and large defects may not be well suited for local reconstruction. In the otolaryngology literature, several reconstructive options using local tissue and synthetic materials have been described, but there have been no reports of microvascular free flaps utilized in this regard. We present a unique case of a 37-year-old woman with a 3.0 cm × 3.5 cm nasoseptal perforation secondary to cocaine use successfully reconstructed with a temporoparietal fascia free flap anastomosed to the facial artery and vein. Postoperatively, the patient had a well-healed septal defect from the free flap reconstruction This new technique shows promise as a feasible option for patients with large defects and for those with limited local reconstructive options. The ease of harvest and low donor-site morbidity make the temporoparietal fascia flap a suitable option for repair of complex nasoseptal defects.

Temporoparietal Fascia Free Flap for a Large Nasal Septal Perforation

“…6 As a thin and malleable flap with rich vascularity, the TPF flap is well suited for the repair of complex nasal defects and has been described for reconstruction of nasal lining, skin cover, and septum. [13][14][15] As this case highlights, the TPF flap imparts minimal donor-site morbidity and leaves a relatively inconspicuous scar, which is especially important in patients who are concerned with the cosmetic outcome. In comparison to the often-bulky radial forearm flap, the TPF flap is significantly thinner and thus obviates the potential need for debulking.…”

Closure of Nasal Septal Perforations Using a Diced Cartilage in Fascia Graft

“…The fascia itself serves as a framework for fibroblast growth from the surrounding mucoperichondrium and as a durable attachment for the graft. 34 In patient 9, the crushed cartilage had slipped off to the nasal floor with the fascia still being attached to the cranial edge of the defect zone. Over time reperforation occurred in the cartilage-free portion of the graft.…”

“…With its low vascular requirements and its framework for fibroblast growth, fascia is a viable graft. 34 In combination with cartilage, volume and stability are increased. In 1997, Hussain and Murthy published their work on a modified tragal cartilage-temporoparietal and deep temporalis fascia sandwich graft claiming a 100% success rate in closing defects up to 4 cm in diameter.…”

Implications of Free Temporoparietal Fascial Flap Reconstruction in the Pediatric Population

“…The FTPFF also has a predictable anatomy, a robust vascular pedicle, and may be harvested and transferred simultaneously to decrease operative times. This flap has been applied in a wide range of reconstructions including contralateral ear/scalp repairs, 12 nasal defect repairs, 15 tracheal/pharyngeal coverage, 16 as a gliding surface in coverage of nerves, tendons, and joints, 17 and for soft tissue defects of the upper and lower extremities 18 . Dissection of the FTPFF is often tedious and requires meticulous microsurgical technique, however, potential complications of alopecia and sensory nerve damage may be avoided if care is taken during harvest.…”