Bilateral Temporal Myofascial Flap for the Reconstruction of Frontal Sinus Defects

Gagliardi, Filippo; Bailo, Michele; Spina, Alfio; Boari, Nicola; Donofrio, Carmine Antonio; Piloni, Martina; Gragnaniello, Cristian; Caputy, Anthony J.; Mortini, Pietro

doi:10.1016/j.wneu.2017.08.022

Cited by 12 publications

(6 citation statements)

References 19 publications

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“…Major drawbacks are the narrow arc of rotation and the poor aesthetic result. [18][19][20] Free vascularized flaps provide great flexibility and the possibility to introduce a large amount of vital tissues in a single stage. They include cutaneous and myocutaneous flaps, as already reviewed in our previous report.…”

Section: Discussionmentioning

confidence: 99%

Local Pterional Advancement Flap: A Minimally Invasive Option to Reconstruct Spheno-Temporal Extracranial Soft Tissues Dehiscences in Fragile Patients

Gagliardi¹,

Giordano

Bussi

et al. 2021

Journal of Craniofacial Surgery

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Background: Late-onset, extracranial soft tissues dehiscence in the spheno-temporal region after major neurosurgical procedures might represent a potentially life-threatening complication.Due to surgery-related galeal/pericranial and myofascial temporal atrophy, classical regional flaps are often unavailable, enforcing potential indication for free vascularized flaps.Nevertheless, in elderly multioperated patients, who are not eligible for major surgery, it becomes mandatory to consider less invasive options for reconstruction.Authors describe the application of a reconstructive option for late-onset, pterional soft tissues dehiscence in fragile patients, using a local pterional advancement flap. Methods: Technique is stepwise described and illustrated in its clinical application. Results: Local pterional advancement flap provides an excellent coverage, being extremely pliable, and flexible in contents and design. Vascular pedicle is independent from distal branches of the superficial temporal artery and provides adequate blood flow. Pedicle length enables a good arc of rotation, which facilitates its transposition. Flap preparation is very easy and minimally time consuming, due to its immediate regional availability and the easy harvesting technique. Conclusions: Local pterional advancement flap represents an effective option as regional flap for the reconstruction of lateonset, pterional soft tissues dehiscence in fragile patients.

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Section: Discussionmentioning

confidence: 99%

Local Pterional Advancement Flap: A Minimally Invasive Option to Reconstruct Spheno-Temporal Extracranial Soft Tissues Dehiscences in Fragile Patients

Gagliardi¹,

Giordano

Bussi

et al. 2021

Journal of Craniofacial Surgery

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“…They are easy to harvest, usually designed as an anteriorly based flap, and highly vascularized by the supraorbital and supratrochlear arteries. [30][31][32] On the other side, free vascularized flaps do provide, as main advantages, a great flexibility and the possibility to introduce, with a single flap, a large amount of vital tissues. [21][22][23][24] Combined pericranial-galeal flaps are more robust and thick and have a superior vascular supply, as compared to purely pericranial ones.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, its utility is limited by the narrow arc of rotation and the poor aesthetic result due to substance loss in the temporal area. [30][31][32] On the other side, free vascularized flaps do provide, as main advantages, a great flexibility and the possibility to introduce, with a single flap, a large amount of vital tissues. They include cutaneous and myocutaneous flaps, as already described in our previous report.…”

Section: Discussionmentioning

confidence: 99%

Temporal myofascial segmentation for multilayer reconstruction of middle cranial fossa floor after extradural subtemporal approach to the clival and paraclival region

et al. 2019

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Background Skull‐base reconstruction represents a concern after resection of middle fossa (MF) tumors by the extradural subtemporal transzygomatic approach (ESTZ). Regional pedicled flaps appear to be the best option. This study describes a technique for temporal myofascial segmentation to harvest a multilayered vascularized flap for MF reconstruction, which might preserve temporal muscle (TM) function and its blood supply. Methods The technique to harvest a combined segmented temporal myofascial flap (CSTMF) is described. The flap consists in a temporal fascial (TFF) and a muscle flap (TMF), composed by TM anterior‐medial bundle (AMB). Results CSTMF provides wide coverage of dural lining, through the TFF, and of dead‐space, through the TMF. The possibility to tailor TMF according to the need, anatomically preserving the blood supply, enables to significantly increase its volume. Conclusion CSTMF represents an effective option as regional multilayered pedicled flap for MF reconstruction, potentially preserving TM function and minimizing the cosmetic impact.

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“…A subgaleal dissection is made and the skin flap is reflected. 21 A bilateral interfascial dissection is performed. Dissection of the upper third of the TM suprazygomatic portion is performed (AMB and MP), starting from the STL downward.…”

Section: Bilateral Temporalis Myofascial Flapmentioning

confidence: 99%

“…Segmentation has maximized flap shape versatility and reconstruction capabilities, thus optimizing cosmetic results. 14,17,18,21,22 Historically, each flap has had its own proponents and opponents, mostly based upon personal experience and surgeon's prevalent field of interest; nevertheless, a pointy review, systematizing techniques and comparatively analyzing different flaps, was still missing in the literature.…”

Section: Introductionmentioning

confidence: 99%

Temporal Flaps in Head and Neck Reconstructive Surgery: A Systematic Review of Surgical Techniques

Gagliardi

Snider

Pompeo

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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The temporal region is a great source of vascularized flap, providing extremely variable and versatile options for reconstruction in head and neck surgery. Its popularity has led to the conception of a large variety of different flaps, in terms of contents and design. Temporal flaps are highly pliable and flexible, providing adequate bulk to obliterate dead spaces and improving engraftment, thus facilitating wound healing. The need to access different anatomical compartments, often far from the original flap anatomical site, has led surgeons to develop techniques to enlarge pedicles and bulk, by reverting and splitting flaps' contents, as well as through partial mandibular and zygomatic resection. To further increase versatility, a multilayered combination of different regional tissues and muscle segmentation techniques has been described. Historically, each flap has had its own proponents and opponents, but a pointy review systematizing techniques and comparatively analyzing different flaps was still missing in the literature. The field of use of some flaps has been progressively limited by the increasing relevance of free tissue transfers, which nowadays may provide success rates up to 95% with a constrained morbidity, thus offering an effective alternative, when available. Given the wide range of reconstructive strategies based on temporal flaps, there is still a great debate on nomenclature and surgical techniques. The present study systematizes the topic, classifying regional flaps according to contents and indications. Harvesting techniques are described stepwise and schematically illustrated, thus offering an indispensable tool to the armamentarium of reconstructive surgeons.

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Bilateral Temporal Myofascial Flap for the Reconstruction of Frontal Sinus Defects

Cited by 12 publications

References 19 publications

Local Pterional Advancement Flap: A Minimally Invasive Option to Reconstruct Spheno-Temporal Extracranial Soft Tissues Dehiscences in Fragile Patients

Local Pterional Advancement Flap: A Minimally Invasive Option to Reconstruct Spheno-Temporal Extracranial Soft Tissues Dehiscences in Fragile Patients

Temporal myofascial segmentation for multilayer reconstruction of middle cranial fossa floor after extradural subtemporal approach to the clival and paraclival region

Temporal Flaps in Head and Neck Reconstructive Surgery: A Systematic Review of Surgical Techniques

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