Use of the temporoparietal free fascial flap in the upper extremity.

Reconstruction of hand coverage has been limited to flaps with the drawbacks of bulkiness and donor-site morbidity. In contrast, the temporoparietal fascia is a thin, pliable, well-vascularized sheet of tissue available in abundant quantity. It leaves an inconspicuous donor site within the hair-bearing scalp. In addition, microvascular transfer is facilitated by the consistent, reliable, and large-caliber axial superficial temporal vascular supply. The branches of the superficial temporal system provide flexibility in designing axial-pattern flaps. Secondary reconstructive surgery can be safely performed beneath the flap. The intrinsic vascularity of the flap may be useful in revascularizing scarred or irradiated areas. There is also the potential to transfer cranial bone as a composite temporoparietal osteofascial free flap to the hand. There has been partial flap necrosis and permanent alopecia at the donor site in only 1 of 12 patients. We recommend this flap based on our experience in these 12 patients.