The temporoparietal fascia has been extensively used solely for ear reconstruction or as a component of a composite tissue flap to cover exposed cartilage, autogenous grafts, or a silastic framework.1-8 Since it was recognized that this flap could survive apart from the temporalis muscle on the superficial temporal vessels, the temporoparietal fascial flap has been elevated as a pedicled flap for soft tissue cover, scalp reconstruction, and contour restoration in the head and neck area. 1,3,4,7-10

The temporoparietal fascia was first transplanted as a free flap to the lower extremity in 1979.11 It has since been used as a free tissue transfer in reconstructing the head, neck, and upper extremity.1,2,10,12,13 This fascial sheet carries blood into the underlying calvarial bone through connections with the underlying pericranium.14-16 A temporoparietal osteofascial flap has been used to carry cranial bone to the jaw for mandibular reconstruction. 14

This flap has proved to be a valuable reconstructive tool. It can be used as a fascial flap alone, a fasciocutaneous flap, or an osteofascial flap. It can be raised as a pedicle flap, island flap, or free flap. It has an excellent blood supply, and leaves an inconspicuous donor site. Its most valuable characteristic is its thinness.

Indications

The temporoparietal fascia is a large, thin sheet of fascia available from the temporal, parietal, and occipital areas of the scalp. The nutrient vessels are large and anatomically consistent, facilitating its use as a free flap. This vascular arrangement enhances its safety as a pedicled flap in the head and neck. These qualities make it useful in reconstructing areas where a large, bulky tissue would diminish the desired result. Areas requiring coverage with minimal contour increase or areas requiring pliability and flexibility would benefit from fascial reconstruction. The capability of this fascial flap to carry facial skin, hair-bearing scalp, and cranial bone creates reconstructive possibilities for defects requiring such specialized tissue. The fact that the fascia, which carries the blood supply to these nonfascial components, is so thin means that very little unnecessary bulk is carried to the recipient site.

The donor site of the temporoparietal fascial flap (TPF) is hidden within the hairline of the scalp, which contributes to a good aesthetic result. In free-flap reconstructions, the distance between donor and recipient sites allows two teams to work simultaneously, lessening the operative time.

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