Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 10:
Temporoparietal Fascia Transplantation and Temporoparietal Composite Osteofascial Reconstruction
  structures were repaired, but the soft tissue healing resulted in a metacarpal phalangeal joint contracture. The temporoparietal fascial free flap was chosen to cover the soft tissue defect when the contracture was released. (From Hing, D.N., Alpert, B.S., and Buncke, H.J.: The use of the temporoparietal fascial free flap in the upper extremity. Plast. Reconstr. Surg. 81:534, 1988.)

FIG. 10-01. The gunshot wound to the MP joint area transected vessels, nerves, and tendons and fractured the metacarpal neck.

FIG. 10-02. A coronal incision has been marked to allow harvest of the flap.

FIG. 10-03. A template of the required amount of fascial cover has been drawn onto the superficial surface.

FIG. 10-04. The flap has been harvested through a vertical preauricular incision. The pedicle has been isolated, ready for transfer.

FIG. 10-05. At the recipient site, the soft tissue release has been achieved. An MP capsulotomy and a silastic tendon rod, inserted for tendon reconstruction, were necessary. The TPF flap is shown covering the base of the fourth and fifth fingers. The recipient vessels are the common volar digital artery and vein.

FIG. 10-06. The surface of the fascial flap has been skin-grafted.


FIG. 10-07. Primary closure of the scalp flaps is accomplished over a suction drain.

FIG. 10-8. The fifth MP joint extends fully. Four months later, the tendon rod was replaced with a palmaris longus graft, working beneath the fascial flap.

FIG. 10-9. The appearance of the donor site demonstrates that the incision is well hidden by the hair.


A patient had a soft tissue defect of the foot from a crush injury.

FIG. 10-10. Skin grafting has provided coverage.

FIG. 10-11. The ipsilateral TPF flap has been isolated on its pedicle.

FIG. 10-12. Flap is elevated.

FIG. 10-13. Durable cover has been restored over the tendons.

FIG. 10-14. The donor scar is nearly invisible.


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