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Der temporoparietale Faszienlappen zur Rekonstruktion von Weichteildefekten

Soft tissue reconstruction with a temporoparietal fascial flap (TPFF)

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Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Operationsziel

Defektdeckung mit temporoparietalem Faszienlappen.

Indikationen

Dünner, gut durchbluteter, ein- oder zweischichtiger Faszienlappen. Verwendung als sensible fasziokutane lokale Lappenplastik, als Mehrkomponententransplantat osteofaszial mit und ohne behaarte Kopfhaut sowie als zweischichtiges Sehnengleitlager möglich. Maximal 17 × 14 cm große Weichteildefekte.

Kontraindikationen

Absolut: Vorschädigung des Lappens bzw. Lappenstiels, Arteriitis temporalis, Defekte mit Volumenverlust, Moyamoya-Syndrom.

Relativ: Alopezie im Bereich der Schnittführung.

Operationstechnik

Präoperative dopplersonographische Darstellung der Stielgefäße (A. temporalis superficialis mit Endästen und Begleitvene). Anzeichnen der Schnittführung. Unterspritzung mit verdünnter Adrenalinlösung. Darstellung der temporoparietalen Faszie und Stielgefäße, wobei die Schonung der Haarbälge besonderer Aufmerksamkeit bedarf. Primärverschluss des Hebedefekts. Vollhaut oder Spalthautdeckung des Lappens und Vakuumversiegelung bzw. Anlage eines Überknüpfverbands.

Nachbehandlung

Ruhigstellung bei Defektdeckung an den Extremitäten in Lappenentlastungsposition, Hochlagerung zur Unterstützung des venösen Abflusses. Entfernung der Vakuumversiegelung bzw. des Überknüpfverbands am 5. postoperativen Tag. Beginn des Lappentrainings ab dem 7. postoperativen Tag. Fadenzug/Klammerentfernung an der Lappenentnahmestelle nach 5–7 Tagen, an der Empfängerregion nach 8–10 Tagen. Kompressionsbehandlung durch elastische Verbandsanlage oder Tragen eines Kompressionsüberzugs.

Ergebnisse

Bei 8 Patienten wurde der temporoparietale Faszienlappen zur Rekonstruktion von Weichteildefekten verwendet. In 2 Fällen kam der Lappen gestielt zur Anwendung. Die mittlere Einheilungszeit betrug 16,3 Tage, die mittlere Nachuntersuchungszeit 13,4 Monate. In allen Fällen konnte eine erfolgreiche Rekonstruktion mit gutem funktionellem und ästhetisch ansprechendem Ergebnis erzielt werden. Komplikationen wurden bei 3 Patienten beobachtet. Diese waren in einem Fall die iatrogene Schädigung des R. frontalis n. facialis, das Auftreten einer Alopezie an der Lappenentnahmestelle in einem weiteren Patienten und letztlich die Notwendigkeit der frühzeitigen (erfolgreichen) Revision bei Beeinträchtigung der Lappendurchblutung.

Abstract

Objective

Soft tissue reconstruction with a temporoparietal fascial flap (TPFF).

Indications

Defect coverage with thin, pliable, and well-vascularized tissue. A bilayered TPFF provides a gliding surface in tendon reconstruction. Further options include TPFF harvest with overlying skin or subjacent bone for composite tissue reconstruction or the application as a sensate local fascial flap. Maximum defect dimensions: 17 × 14 cm.

Contraindications

Absolute: prior injury to the flap or flap pedicle, temporal arteritis, Moyamoya syndrome, defects with volume deficit.

Relative: alopecia along the planned incision.

Surgical technique

Pedicle location is outlined using Doppler ultrasound. Injection of the incision line with diluted epinephrine solution. Skin incision with subsequent visualization of the temporoparietal fascia and supplying vessels. Skin flaps are raised carefully paying special attention to the hair follicles (CAVE: postoperative alopecia). Primary closure of the donor site. Defect coverage with pedicled or free TPFF with subsequent full or split-thickness skin grafting. Dressing: Bolster or V.A.C.

Postoperative management

Immobilization/elevation in the setting of extremity reconstruction. Removal of bolster dressing or V.A.C. on postoperative day 5. Dangling protocol instituted on postoperative day 7. Removal of sutures/staples at the donor site on postoperative day 5–7 and at the recipient site on postoperative day 12–14.

Results

The TPFF was utilized for soft tissue reconstruction in 8 patients. A pedicled TPFF was used in 2 patients. Mean time to healing was 16.3 days. Mean follow-up was 13.4 months. Successful reconstructive results with satisfactory functional and aesthetic appearance were obtained in all patients. Complications were encountered in 3 patients and included alopecia at the donor site and iatrogenic injury to the frontal branch of the facial nerve. Vascular compromise was observed in the early postoperative period in a third patient. However, operative revision resulted in successful flap salvage.

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Literatur

  1. Abul-Hassan HS, Ascher GD, Acland RD (1980) Surgical anatomy and blood supply of the fascial layers of the temporal region. Plast Reconstr Surg 77(1):7–28

    Google Scholar 

  2. Agarwal CA, Mendenhall SD, Foreman KB et al (2010) The course of the frontal branch of the facial nerve in relation to fascial planes: an anatomic study. Plast Reconstr Surg 125:532

    Article  PubMed  CAS  Google Scholar 

  3. Beheiry EE, Abdel-Hamid FAM (2007) An anatomical study of the temporal fascia and related temporal pads of fat. Plast Reconstr Surg 119:136

    Article  PubMed  CAS  Google Scholar 

  4. Biswas G, Lohani I, Chari PS (2001) The sandwich temporoparietal free fascial flap for tendon gliding. Plast Reconstr Surg 108(6):139–140

    Article  Google Scholar 

  5. Brent B, Upton J, Acland RD et al (1985) Experience with the temporoparietal fascial free flap. Plast Reconstr Surg 76:177

    Article  PubMed  CAS  Google Scholar 

  6. Carty MJ, Taghinia A, Upton J (2010) Fascial flap reconstruction of the hand: a single surgeon’s 30-year experience. Plast Reconstr Surg 125(3):953–962

    Article  PubMed  CAS  Google Scholar 

  7. Chen TH, Chen CH, Shyu JF et al (1999) Distribution of the superficial temporal artery in the Chinese adults. Plast Reconstr Surg 104(5):1276–1279

    Article  PubMed  CAS  Google Scholar 

  8. Czerwinski F (1992) Variability in the course of the superficial temporal artery in man. Folia Morphol (Warsz) 51(1):49–54

    Google Scholar 

  9. David SK, Cheney ML (1995) An anatomic study of the temporoparietal fascial flap. Arch Otolaryngol Head Neck Surg 121(10):1153–1156

    Article  PubMed  CAS  Google Scholar 

  10. Davidson SP, Mesbahi AN, Clemens MW et al (2008) Vascularized calvarial bone flaps and midface reconstruction. Plast Reconstr Surg 122(1):10e–18e

    Article  Google Scholar 

  11. Gosain AK, Sewall SR, Yousif NJ (1997) The temporal branch of the facial nerve: how reliably can we predict its path? Plast Reconstr Surg 99(5):1224–1233; discussion 1234–1236

    Article  PubMed  CAS  Google Scholar 

  12. Hentz VR, Pearl RM (1987) Application of free tissue transfers to the foot. J Reconstr Microsurg 3(4):309–320

    Article  PubMed  CAS  Google Scholar 

  13. Hing DN, Buncke HJ, Alpert BS (1985) Free flap coverage of the hand. Hand Clin 1:741–758

    PubMed  CAS  Google Scholar 

  14. Hing DN, Buncke HJ, Alpert BS (1988) Use of the temporoparietal free fascial flap in the upper extremity. Plast Reconstr Surg 81:534

    Article  PubMed  CAS  Google Scholar 

  15. Hirase Y, Kojima T, Bang HH (1991) Double-layered free temporal fascia flap as a two-layered tendon-gliding surface. Plast Reconstr Surg 88(4):707–712

    Article  PubMed  CAS  Google Scholar 

  16. Iblher N, Eisenhardt SU, Penna V et al (2010) A new evaluation tool for monitoring devices and its application to evaluate the implantable Doppler probe. J Reconstr Microsurg 26(4):265–270

    Article  PubMed  Google Scholar 

  17. Kim JC, Hadlock T, Varvares MA et al (2001) Hair-bearing temporoparietal fascial flap reconstruction of upper lip and scalp defects. Arch Facial Plast Surg 3(3):170–177

    Article  PubMed  CAS  Google Scholar 

  18. Lai A, Cheney ML (2000) Temporoparietal fascial flap in orbital reconstruction. Arch Facial Plast Surg 2:196–201

    Article  PubMed  CAS  Google Scholar 

  19. Marano SR, Fischer DW, Gaines C, Sonntag VKH (1985) Anatomical study of the superficial temporal artery. Neurosurgery 16(6):786–789

    Article  PubMed  CAS  Google Scholar 

  20. Matsuba HM, Hakki AR, Romm S et al (1990) Variations on the temporoparietal fascial flap. Laryngoscope 100:1236–1240

    Article  PubMed  CAS  Google Scholar 

  21. Mitz V, Peyronie M (1976) The superficial musculo-aponeurotic system (SMAS) in the parotid and cheek area. Plast Reconstr Surg 58:80–82

    Article  PubMed  CAS  Google Scholar 

  22. Parhiscar A, Har-El G, Turk JB et al (2002) Temporoparietal osteofascial flap for head and neck reconstruction. J Oral Maxillofac Surg 60:619–622

    Article  PubMed  Google Scholar 

  23. Pinar YA, Govsa F (2006) Anatomy of the superficial temporal artery and its branches: its importance for surgery. Surg Radiol Anat 28:248–253

    Article  PubMed  Google Scholar 

  24. Pitanguy I, Silveira Ramon A (1966) Frontal branch of the facial nerve: the importance of its variations in face lifting. Plast Reconstr Surg 38:352

    Article  PubMed  CAS  Google Scholar 

  25. Rose EH, Norris MS (1990) The versatile temporoparietal fascial flap: adaptability to a variety of composite defects. Plast Reconstr Surg 85:224–232

    Article  PubMed  CAS  Google Scholar 

  26. Smith RA (1980) The free fascial scalp flap. Plast Reconstr Surg 66(2):204–209

    Article  PubMed  CAS  Google Scholar 

  27. Stock AL, Collins HP, Davidson TM (1980) Anatomy of the superficial temporal artery. Head Neck Surg 2:466–469

    Article  PubMed  CAS  Google Scholar 

  28. Strauch B, Yu H-L, Chen Z-W et al (1993) Atlas of microvascular surgery, anatomy and operative approaches. Thieme Medical Publishers, New York, S 526–537

  29. Tayfur V, Edizer M, Magden O (2010) Anatomic bases of superficial temporal artery and temporal branch of facial nerve. J Craniofac Surg 21:1945–1947

    Article  PubMed  Google Scholar 

  30. Tolhurst DE, Carstens MH, Greco RJ et al (1991) The surgical anatomy of the scalp. Plast Reconstr Surg 87(4):603–612

    Article  PubMed  CAS  Google Scholar 

  31. Woods JM, Shack BR, Hagan KF (1995) Free temporoparietal fascia flap in reconstruction of the lower extremity. Ann Plast Surg 34:501

    Article  PubMed  Google Scholar 

  32. Zani R, Fadul R Jr, Da Rocha MA et al (2003) Facial nerve in rhytidoplasty: anatomic study of its trajectory in the overlying skin and the most common sites of injury. Ann Plast Surg 51(3):236–242

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Abteilung Plastische und Handchirurgie, Chirurgische Universitätsklinik Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland

    G. Koulaxouzidis, N. Torio-Padron, F. Lampert, H. Zajonc, H. Bannasch & G. Björn Stark

  2. Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, USA

    A. Momeni

Authors
  1. G. Koulaxouzidis
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  2. N. Torio-Padron
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  3. A. Momeni
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  4. F. Lampert
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  5. H. Zajonc
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  6. H. Bannasch
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  7. G. Björn Stark
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Correspondence to G. Koulaxouzidis.

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Koulaxouzidis, G., Torio-Padron, N., Momeni, A. et al. Der temporoparietale Faszienlappen zur Rekonstruktion von Weichteildefekten. Oper Orthop Traumatol 24, 32–42 (2012). https://doi.org/10.1007/s00064-011-0097-8

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  • DOI: https://doi.org/10.1007/s00064-011-0097-8

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