Temporoparieto-Occipital and Temporoparieto-Occipitoparietal Scalp Flaps

EDITORIAL COMMENT

The following four chapters (Chapters 4-7) describe a series of techniques for restoration or transfer of hair-bearing skin about the scalp. These flaps have found their greatest usefulness in treating acquired baldness. They are most helpful with the adjunctive insertion of microvascular grafts, as well as the use of additional free multiple and single hair-bearing grafts.

In the treatment of frontal or frontoparietal alopecias, the temporoparieto-occipital flap is the method of choice, since it provides enough hair to cover the alopecic area up to the contralateral region (1, 2, 3, 4, 5, 6). The flap can be extended if necessary as the temporoparieto-occipitoparietal scalp flap (7, 8, 9).

INDICATIONS

These flaps have the valuable advantage that the donor area is closed by approximation of its edges, at the expense of a large retroauricular advancement flap.

FIGURE 4.1 Schematic representation of the temporoparieto-occipital flap. A: Design of the anterior implant line and recipient area. B: Flap design. C: Flap transposition and closure of the donor area with a large advancement flap (arrows). D: Flap in its final position and sutured to the recipient site. (From Juri et al., ref. 6, with permission.)

When the alopecia affects the frontal area (Figs. 4.1 and 4.2), only one flap will be required to close the defect. If the alopecia also involves the parietal region, a second flap from the contralateral zone is placed behind the first one a month later.

When a large area of central alopecia cannot be covered completely, an extended flap (Figs. 4.3 and 4.4) can be used not only to cover part of the defect, but also to help camouflage the remaining defect with an appropriate hairstyle.

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