Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 10:
Temporoparietal Fascia Transplantation and Temporoparietal Composite Osteofascial Reconstruction
  The temporoparietal fascia free flap has been used in the lower extremity primarily for soft tissue coverage in open wounds caused by trauma or burns. It has also been used in open fractures of the tibia that have not healed because of skin injury or infection.17 The excellent blood supply of the fascial flap may decrease the local wound contamination. For larger wounds or deeper defects, muscle flaps are preferable. Replacing unstable surface coverage in the lower extremity with temporoparietal fascia can also release contractures and lead to gliding of underlying tendons.2

In the upper extremity, the temporoparietal fascia flap can provide a thin, soft tissue cover that will permit early hand therapy with less edema. Fascia covered by skin graft can resurface acute wounds. Exposed tendons, nerves, bone, and vessels have been salvaged in this manner. Silastic tendon rods have also been covered primarily by free fascial flaps. 2,12,13 The skin-grafted fascia permits tendon motion beneath its surface. If additional secondary reconstruction is necessary, the fascia can be re-elevated for further surgery without loss of tissue cover.12 This flap has been elevated or undermined to place tendon grafts, perform tenolyses, and place a functional muscle transplant. The amount of available fascia may permit combined coverage of the dorsal and volar aspects of the hand. We have not yet used composite tissue transfers in the hand with the temporoparietal fascia as a carrier, but the osteofascial free flap has potential for metacarpal shaft reconstruction.


Composite fascial flap reconstruction may be most appropriate in the head and neck. Here, the need for replacing missing tissue with similar tissue is answered by delivering facial skin, hair-bearing scalp, or cranial bone on a vascularized fascial carrier. These problems are solved on the ipsilateral side by using pedicled flaps when possible. If those tissues are not suitable on the side of the defect, free composite tissue transfer is necessary.

Hair-bearing scalp and facial skin have been brought to areas lacking these tissues because of burn wounds.2 Forehead skin has been transplanted on a fascial carrier to reconstruct nasal skin lost to skin cancer. Fascial flaps have been used to provide contour restoration in the cheek and orbital area.9 We have used a pedicled flap to reconstruct mandible resected for parotid gland tumor. 14 Intraoral lining can also be provided with the temporoparietal fascial flap. Many potential applications exist in the head and neck.

Technical Considerations

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