Islanded Superficial Temporal Artery Fasciocutaneous Flap in Temporal Hairline Reconstruction Following Skin Cancer: A Novel Approach.

Skin cancer defects spanning the temporal hairline present unique challenges. The junction between hair-bearing and non-hair-bearing skin is not a straight line, making it difficult to recruit hair-bearing scalp tissue to precisely fit its geometry. An aesthetically pleasing reconstruction should place scars in natural positions along the hairline, minimize tension during closure, preserve the direction and location of hair growth, and replace like tissue with like. The islanded superficial temporal artery fasciocutaneous flap (ISTAFF) mobilized in a V-Y fashion includes the galea and superficial temporal fascia and is supplied by the superficial temporal artery and vein pedicle. It represents a valid but seldom-described alternative to commonly used random pattern flaps, large rotational flaps, and skin grafting with tissue expansion, which may fail to address the different qualities of skin and scalp subunits intersecting at the hairline. In this small 3-case series, we demonstrate that the ISTAFF mobilized in a V-Y fashion is a simple yet effective method for reconstructing smaller defects of the temporal hairline. We also present a novel combination of the ISTAFF with other local flaps, namely a rectangular advancement flap and a rhomboid flap, to achieve tension-free and aesthetically pleasing reconstruction of large defects in this area, while respecting hair growth patterns and the natural course of the hairline.