The Temporoparietal Fascial Flap in Skull Base and Head and Neck Reconstruction: Technique, Experience and Review

Objectives: The temporoparietal fascial flap (TPFF) is a uniquely versatile and reliable technique with a wide array of applications in reconstructive head and neck, neurotologic and skull base surgery. The TPFF has a predictable and rich vascular anatomy allowing for survival and healing in unfavorable conditions. Its wide rotational arc, long vascular pedicle length and available surface area allow for reconstruction of a variety of moderate to large defects while its pliability and thinness enable conformation to most surfaces with even complex geometric shapes. Herein, we report our experience utilizing the TPFF for a variety of head and neck and skull base defects, describe our technique so as to maximize TPFF application while avoiding facial incisions and minimizing morbidity and lastly, provide a comprehensive review of the existing literature.

Study Design: A retrospective case series over a ten year period where a TPFF flap was used.

Methods: This study was conducted with a waiver of oversight from our Institutional Review Board. All patients were included in this series if they underwent reconstruction with a TPFF. Data on demographics, clinical and pathologic features of disease, size and site of reconstruction, outcome measurements and length of follow up were collected. A literature review was performed to identify studies which examined the reconstructive use of the TPFF through the MEDLINE database. Outcomes of the papers identified were compared with our data.

Results: A total of 17 TPFF flaps were performed for reconstructive purposes. 8 were used for skull base defects, while the remainder were used for various other head and neck defects, including auricular, intraoral (palatal), maxillary, and mandibular defects. The majority of skull base reconstruction included posterior (clival) and middle fossa defects after expanded endonasal approaches (EEA). Our data demonstrates low rates of flap failure, scalp flap necrosis or facial nerve injury. For skull base reconstruction, postoperative CSF leak rate is less than 3%. The most common short-term complication was alopecia. No long-term complications were identified.

Conclusion: The TPFF is a reliable method for repair of extensive skull base defects after traditional craniofacial resection, or skull base defects of the anterior, middle, clival and parasellar skull base resulting from an EEA, especially in patients with a history of a posterior septectomy or prior radiotherapy. Our technique avoids facial incisions and has minimal postoperative morbidity. Its versatility may be applied for repair of a variety of head and neck defects.