|| FIG. 10-29. Lateral view. S.T. vessels are marked by Doppler.
FIG. 10-30. Osteoradionecrosis led to the fracture of the left mandible, as seen in this x ray.
FIG. 10-31. Marking of vascular pedicle and osteofascial flap.
FIG. 10-32. A wide flange STF has been elevated up to the edge of the full-thickness bone graft.
FIG. 10-33. The bone graft is cut, connecting burr holes with Gigli saws. The connections between the fascia and underlying bone graft must be preserved at all times to protect the blood supply.
FIG. 10-34. The mandibular defect is easily reached with the fascial pedicle. There is bleeding on the deep surface of the cranial bone graft from connections to the temporoparietal fascial flap. The bone flap is completely encased by the TPF flanges wrapped around it.
FIG. 10-35. The mandibular defect is debrided.
FIG. 10-36. The cranial bone convexity matches the mandibular curve. The fascia is wrapped around the graft to increase the blood supply to the bone in the irradiated recipient site.
FIG. 10-37. Interosseous wires and Kirschner pin fixation were used to achieve stabilization of the cranial bone graft in the mandibular defect.
FIG. 10-38. The fixation is demonstrated on this postoperative x ray.
FIG. 10-39. The cranial defect was reconstructed using split, outer table cranial bone grafts from the periphery. The scalp defect was closed primarily. The pedicle and osteofascial component were covered by local cervical and cheek flaps.
FIG. 10-40. The reconstruction restored bony stability to the mandible and soft tissue countour to the face. Perfusion of the cranial bone was confirmed by a postoperative bone scan.
A 58-year-old man was treated for a nasal basal cell cancer using Mohs chemotherapy and was left with a defect on the right side of his nose. Many local flaps had been attempted without success. The temporoparietal fasciocutaneous flap was selected to bring new tissue to the right nose. (FIGs. 10-41, 10-43, and 10-46 from Hing, D.N., Buncke, H.J., and Alpert, B.S.: Clinical applications of the temporoparietal fascial flap. In Reconstructive Microsurgery, G. Brunelli (Ed.), New York, Springer-Verlag, 1988, pp. 899-910.)