FIG. 10-15. Dorsal view of injury.

FIG. 10-16. Volar view.

FIG. 10-17. To restore volar and dorsal coverage over intact tendons, a bilateral temporoparietal fascial flap was elevated on the right temporal vessels. The template for the defect demonstrates the extensive soft tissue loss.

FIG. 10-18. Right superficial temporal vessels "Dopplered out" and marked over the anterior and posterior branches.

FIG. 10-19. Anterior and posterior coronal scalp flaps.

FIG. 10-20. Bilateral TPF flap elevated as "bucket handle."

FIG. 10-21. The reflected flap matches the template.

FIG. 10-22. The dorsal and volar surfaces are covered with the fascial flap, anastomosing the right superficial temporal vessels end to end to the ulnar artery in the forearm. With strong back bleeding from the left pedicle of the flap, no further anastomoses were performed.

FIG. 10-23

FIG. 10-24. There is a minimal donor defect.

FIG. 10-25. Late follow-up shows good finger extension and completed coverage.

FIG. 10-26. Volar view.

FIG. 10-27. Pinch and grasp.

CASE 4

A 50-year-old man was treated for left submandibular gland mucoepidermoid carcinoma with partial mandibulectomy and radical neck dissection. This was followed with radiation therapy. The mandible subsequently fractured from osteoradionecrosis. The temporoparietal osteofascial flap was chosen to reconstruct the defect with vascularized cranial bone as a pedicled flap. (FIGs. 10-28, 10-33, 10-34, 10-36 and 10-40 from Hing, D.N., Buncke, H.J., and Alpert, B.S.: Clinical applications of the temporoparietal fascial flap. In Reconstructive Microsurgery, G. Brunelli (Ed.), New. York, Springer-Verlag, 1988, pp. 899-910).

FIG. 10-28. Frontal view. Note soft tissue defect.

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