Flaps pedicled on the superficial temporal artery and vein in facial reconstruction: A versatile option with a venous pitfall

Abstract

Flaps pedicled on the superficial temporal vessels are versatile in reconstruction of the face and scalp. Various tissues can be harvested and flexible pivot points and long pedicles allow for them to reach the entire face. Colour and texture match is good, and morbidity at the donor site is usually minimal. However, venous anatomy of the temporal area is unpredictable, and this anatomical point has not been clearly reported in papers and anatomical atlases. One must be aware of the risk of venous inconsistency and plan the pedicle accordingly. In the absence of a suitable vein, drainage can be provided through concomitant veins in a sufficient cuff of fascia around the pedicle's artery. We have reviewed published reports about reconstructive possibilities provided by temporal flaps, for descriptions of the venous drainage of the temporal area, and for salvage procedures in case of venous stasis. We present our own salvage procedure, the "modified poor man's leech", in which continuous venous oozing from a de-epithelialised area is maintained by topical heparin and low molecular weight heparin injections and may save a congested flap.

In vivo analysis of the vascular pattern of the superficial temporal artery based on digital subtraction angiography

“…The arterial diameter of the STA at the level of the zygoma is described by Upton and Rodgers consistently with 1.5–1.7 mm in adults and 0.5–0.9 mm in children . Ausen and Pavlovic reported a mean diameter of the STA of 2 mm after passing the upper border of the parotid gland and of 1.6 mm for each branch directly after the main bifurcation . Marano et al described in their cadaver study the so‐called “working lengths” of the STA.…”

“…In the current literature, the STA is usually described as one of the terminal branches of the external carotid artery, supposed to be relatively stable in its course and caliber . It emerges deep to or within the parotid gland and initially runs in cranial direction under the zygomatic bone within the temporoparietal fascia.…”

“…It emerges deep to or within the parotid gland and initially runs in cranial direction under the zygomatic bone within the temporoparietal fascia. After this point it usually divides into a parietal and frontal branch . The superficial temporal vein (STV) though is described to run independently and the frontal and parietal branches of the STA should be accompanied by thin venae comitantes which originate from the STV according to cadaveric study .…”

Bilateral comparison of the vascular pattern of the superficial temporal artery based on digital subtraction angiography

“…The STA is one of the terminal branches of the external carotid artery, initially running in cranial direction independently from the superficial temporal vein (STV) and is accompanied by thin venae comitantes [1,9]. When the STA emerges deep to, or within the parotid gland, it continues the cranial direction below the zygomatic bone, and plays a crucial role for the blood supply of the lateral head region [16].…”

“…Cadaver studies performed in the past usually described the STA as one of the terminal branches of the external carotid artery supposed to be relatively stable in its course and caliber [1], but these results were proved not conclusive enough. Angiographic methods are promising tools to perform reliable, in vivo anatomic studies of the course of constant vessels.…”