Introduction: The temporo-parietal (TP) fascia flap is a valuable option for orbitomaxillary reconstruction owing to its long arc of rotation, provision of thin, well-vascularized tissue, and minimal donor site morbidity. The TP flap can be used in a variety of configurations including to provide vascularized soft tissue coverage of free bone grafts and/or prosthetic materials and as a vascularized calvarial bone composite flap. The TP fascia flap can be an alternative and/or adjunct to free flap reconstruction, potentially reducing operative time and patient morbidity.

Methods: The medical records of all patients who underwent TP flap reconstruction following oncologic resection of the maxilla, orbit, and/or preauricular area from 1994 to 1998 at The University of Texas M. D. Anderson Cancer Center were retrospectively reviewed. The patient and defect characteristics, operative technique, and surgical and functional outcomes were analyzed.

Results: Eleven patients were included in the study. The tumor pathology was osteosarcoma (3 cases), basal cell carcinoma (3), squamous cell carcinoma (2), sarcomatoid carcinoma (1), chondrosarcoma (1), or neurofibroma (1). Tumors directly invaded the bone of the orbit (6 cases), maxilla (5), zygoma (4), cranium (1), and/or palate (4). Orbital exenteration was required in only 2 cases. Four patients underwent orbital floor reconstruction with a free bone graft (1), titanium mesh (2), and/or a composite TP osteofascial flap (1). Four patients had palatal defects, and all had successful dental rehabilitation with a palatal prosthesis and tolerated a soft or regular diet. There were no donor site complications. There was 1 partial flap failure associated with a cerebrospinal fluid leak in a patient following total orbital exenteration and total maxillectomy; this required a free VRAM flap for salvage. Minor recipient site complications occurred in 3 patients: incomplete take of an intraoral skin graft, preseptal cellulitis, and a 1-cm wound dehiscence (1 case each). At a mean follow-up of 26 months, 9 patients were alive with no evidence of disease, 1 was alive with metastatic disease, and 1 had died of recurrent, invasive disease 13 months postoperatively.

Conclusion: The TP fascia flap is a versatile and reliable option for reconstruction of select orbitomaxillary defects and can be combined with bony reconstruction in a variety of techniques. Advantages include rapid flap harvest and inset, a relatively low complication rate, and good functional outcomes. The TP flap should be considered for reconstruction of orbitomaxillary defects, particularly when free tissue transfer is undesirable or contraindicated.