The Reverse Temporoparietal Fascia Flap

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Abstract

Case Report

A 28-year-old man, after ejection from a motor vehicle, sustained a large, stellate laceration through all the layers of the temporoparietal scalp (Fig. 1). There was extensive contusion to the tissues; the initial therapeutic step chosen was debridement and rough approximation of the wound edges. Due to the extent of soft-tissue crush, progressive necrosis of the wound necessitated subsequent debridement of devitalized tissue. This debridement resulted in exposed calvarium (Fig. 2).

Case Report

After stabilization of the wound, the patient was returned to the operating room. After wound debridement, the fullthickness scalp loss measured 10 × 10 cm. There was an abutting 5 × 5 cm area of partial scalp loss down to the loose areolar tissue above the periosteum.

Case Report

A staged reconstruction was planned. The initial stage was the coverage of the calvarium, while preserving later reconstructive options. This coverage was performed through the use of what we term the “reverse temporoparietal fascia flap.” The reverse temporoparietal fascia flap was elevated from the level of the auricle while staying 1 cm caudal (inferior) to the temporal suture (Figs. 3 and 4).

Case Report

Through the surgical maneuver of turning the reverse temporoparietal fascia flap, the bare calvarium was covered. Because of the large size of the tissue deficit, flap dissection was accomplished through elevation of the wound edges. A split-thickness skin graft was applied on the flap's surface. There was complete healing of both the flap and graft (Fig. 5). Later reconstruction of the hair bearing scalp was accomplished by means of tissue expansion techniques.

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