Ann. MediL Burns Club - vol. VII - n. 1 - March 1994


Stamatopoulos C., Alexakis R, Tsoutsos D., Michaelidis Ch., Kastana 0., loannovich J, Soumilas A.

Department of Plastic Surgery and Microsurgery, General State Hospital of Athens, Greece

SUMMARY. The temporal artery and the temporary vein are vessels with a constant anatomical course, large diameter and long axis with no deviations in the zygomaticotemporal region. The distribution of the contributory vessels is such that it allows dissection of flaps from the scalp and forehead. Dissection of the various flaps is facilitated by the existence of the fascia temporalis, which clarifies the position of the vessels. These characteristics of temporalis flaps broaden their versatility in the reconstruction of post-burn defects of the head and neck. The use of tissue expanders in the temporalis area further enhances the versatility of these flaps. The dimensions of the flaps can thus be enlarged to cover extensive defects in the neck region, and donor sites are closed primarily. Fifteen cases in which temporalis artery flaps were used are presented in this study, together with a discussion of details of their dissection and the use of tissue expanders in head and neck reconstruction.

The reconstruction of face and scalp defects due to trauma or post-burn scars presents the surgeon with great problems, particularly with regard to the need to transfer a hairy flap for the reconstruction of the neck in males. However, thin non-hairy skin is sometimes needed for the reconstruction of a complex anatomical site such as the nose.
The purpose of this study is to describe the application, versatility and selection of flaps based on superficial temporal artery branches.Their versatility is due to their shape, location and texture, resulting from the constant branches of the artery and the anastomoses between them.The present study was based on 15 cases treated in 1992 and 1993 in our Department (nine males and six females; age-range: 20 to 45 years). Six patients required forehead and scalp reconstruction, three eyebrow reconstruction, one nose reconstruction and five chin and cheek skin defects. The five last cases were male patients with post-burn (two to three years) scars covering the face. Four of these five patients also presented neck contracture.The neck contracture complication required the use of a flap nearly 8 em wide. This was possible only after the use of tissue expanders and simultaneous direct closure of the donor site. The temporoparietal area did not present scars in any of the cases, and identification of the vessels was easily made by Doppler.
After a six-to-seven-week expansion period the expanders were removed and a bipedicled flap was transferred and sutured to the chin and cheek defect. The donor site was closed directly in all cases but one. In this case the patient expressed the preference to be operated on unilaterally without the use of a tissue expander. However, he subsequently requested the use of tissue expansion and reconstruction of the contralateral side in addition to the donor site of the first operation.
In three cases, small island hairy flaps based on the rear branch of the superficial temporal artery were transferred for eyebrow reconstruction. In two of these cases the eyebrow defect was due to post-burn scars, while in the third it was due to tumour removal in childhood.
In one case of nose hypoplasia we used the tempororetroauricular flap described by Washio for nose reconstruction. Using the anastomoses between the branches of the superficial temporal artery and the retroauricular artery, the design of a genuine axial pattern flap was possible. Six cases concerned full-thickness burns of the temporal and forehead areas. A tissue expander was obligatory for reconstruction of the hair line.
In conclusion, the advantages of these flaps on the basis of our experience were:

  • constant anatomical localization and large diameter of the
  • vessels;
  • versatility;
  • long vascular pedicle;
  • safe preparation;
  • easy identification of vessels by Doppler;
  • flap enlargement by tissue expander; and
  • direct closure of the donor site.

The disadvantages are the colour and thickness of the skin, the two-stage reconstruction in the case of tissue expander use, and the direction of natural hair growth.

RESUME. L'artère temporale et la veine temporale sont des vaisseaux avec un parcours anatomique constant, un grand diamètre et un long axe sans aucune déviation dans la région zygomaticotemporale. La distribution des vaisseaux affluents permet la dissection les lambeaux du scalp et du front. La dissection est facilitée par l'existence de la fascia temporalis qui indique la position des vaisseaux. Ces caractéristiques des lambeaux temporaux augmentent les possibilités d'emploi dans la reconstruction des défauts de la tête et du cou dus aux brûlures. L'emploi de la technique de l'expansion tissulaire dans la région temporale augmente ultérieurement les possibilités offertes par ce type de lambeau. De cette manière les dimensions du lambeau peuvent être agrandies pour couvrir les défauts étendus dans la région du cou, et les sites donneurs de peau peuvent être fermés primairement. Les auteurs présentent 15 cas où les lambeaux de l'artère temporale ont été employés, avec une discussion des détails de la dissection des lambeaux et de l'emploi de la technique de l'expansion tissulaire dans la reconstruction de la tête et du cou.


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