Temporoparietal Fascial Flap in Orbital Reconstruction

Abstract

To evaluate the success of the temporoparietal fascial flap (TPFF) in the primary or secondary reconstruction of difficult orbital defects and to review the surgical techniques.Design: Retrospective analysis.Setting: Tertiary medical center.Patients: Nine patients with diverse orbital cavity or periorbital soft tissue and bony defects due to trauma, benign or malignant neoplasms, and radiation treatment.Interventions: Temporoparietal fascial flap anatomy and techniques of harvest and inset are reviewed in detail. Four cases are presented to illustrate possible variables in orbital reconstruction. Variables examined include the location of defects, the success of flap survival in orbital cavities after primary or secondary reconstruction, the effects of prior irradiation on flap survival, and the possibility of concurrent osteointegrated implant placement with TPFF reconstruction.Main Outcome Measures: Functional and aesthetic outcomes were determined by physical examination and preoperative and postoperative photographs.Results: All patients had successful transfer of TPFF grafts without flap compromise. Temporoparietal fascial flap was a viable option for subtle orbital and malar contour defects. In chronically inflamed wounds such as with osteoradionecrosis and orbitoantral fistula, TPFF successfully restored vascularity, obliterated the defects, and enabled the placement of osteointegrated implants. The TPFF also supported the concurrent placement of a free calvarial bone graft. Finally, split-thickness skin grafted onto a pedicled TPFF showed 100% survival. Conclusions:The TPFF is one of the most reliable and versatile regional flaps in the head and neck for orbital reconstruction. This study presents the use of TPFF in a variety of orbital defects, from lateral bony rim defects to total exenteration. Timing of repair in this study spans from immediate reconstruction to reconstruction delayed more than 50 years after the initial injury. In all cases, reconstruction with TPFF resulted in improved bony and soft tissue contours, and incurred minimal morbidity.

Der temporoparietale Faszienlappen zur Rekonstruktion von Weichteildefekten

“…Als gestielter osteofaszialer Mehrkomponentenlappen ist die Anwendung bei Rekonstruktionen der Orbita, des Mittelgesichts und Kiefers nach Trauma, Tumorresektion oder Bestrahlung sinnvoll [10,18,22]. Insbesondere bei einem ersatzschwachen Lager mit reduzierter Durchblutung und erhöhtem Infektionsrisiko hat der gestielte vaskularisierte Knochentransfer seine Vorteile gegenüber einer freien Knochentransplantation oder gar der Verwendung von Prothesen.…”

Novel Use of Unilateral Galeopericranial Flaps for Closure of Sino‐Orbital Cutaneous Fistulas

“…Primary closure and secondary intention are usually a poor option. Authors have described using temperoparietal fascia 5 , orbital skin and mucosa 6 , uncinate or inferior turbinate flaps 1 , and midline forehead flaps. 7 The common theme among these articles is that a two-layered closure is required.…”

Orbitastabilisierung mit Suprabrow-Periosttranspositionslappen

“…Tabelle 1). [3] an, welche auch eine Reinsertion des oberen Obliquusmuskels ermöglichen und die bei größeren Defekten des Orbitaunterrandes und -bodens des Jochbeines auch muskulär gestielt (Temporalis) werden können [8,9].…”

“…Freie oder gestielte Lappen zur Rekonstruktion solcher mediokaudalen Strukturdefekte wurden bisher nicht beschrieben []. Für verschieden große Orbitadefekte bis hin zur Exenteratio wurde ein gestielter myofaszialer Temporalislappen beschreiben, der jedoch lediglich Voumendefekte auffüllt [9].…”