Temporoparietal Fascial Flap for Nasal Reconstruction

EDITORIAL COMMENT

This chapter presents another source of tissue for reconstruction of the ala nasi. Obviously, it is not a first or second choice. If used at all, it would be most applicable for patients with male pattern baldness.

An axial subcutaneous fascial flap based on the superficial temporal vessel and its major branches has provided an alternative method for reconstruction of full-thickness defects of the ear and anterior upper half of the face (1, 2, 3). The development and use of this flap for nasal reconstruction are logical extensions of its potential.

Stimulated by Corso’s demonstration (4) of a paucity of venous drainage within the terminal areas of arterial branching, I have modified the design of the axial subcutaneous fascial flap to achieve both a longer pedicle and improved viability.

INDICATIONS

Nasal defects can often be reconstructed from local tissue sources. However, further experience will determine the reliability and applicability of the temporoparietal fascial flap for these defects. Advantages of this flap include (1) transposition of a well-vascularized, thin, and pliable flap that accepts grafts on either side as needed, (2) reconstruction in a single stage, and (3) transposition of tissue outside the area of trauma, radiation, or tumor.

Potential difficulties with this flap are (1) variability in vascular distribution, (2) paucity of venous drainage, (3) inadequate pedicle length, and (4) loss of hair at the donor site.

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