The temporoparietal fascial flap is a reliable, versatile, and strong flap that may be used pedicled or free to treat a wide variety of difficult problems. Temporoparietal fascia flaps are well vascularized, thin and pliable, and readily accept skin grafts. In 1993, Cheney et al¹ described 21 cases using the flap for a variety of reconstructions in the head and neck. An analysis of 123 temporoparietal fascia flaps by Park et al² in Korea reported a 94% success rate using these flaps for total auricular reconstructions. Temporoparietal flaps can drape into concavities and over convexities, are resistant to infection, and are particularly useful in trauma settings, devascularized wounds, and wounds with large tissue deficits. Wounds with large tissue deficits are complicated by large fluid losses, nutritional deficits, increased metabolic rates and increased chance of infection. Temporoparietal flaps are also used in the management of wounds that have failed previous conservative and surgical wound healing interventions. Frequently these patients have multiple medical comorbidities including diabetes, peripheral vascular disease, depressed immune systems, or radiated tissues.
In the past, the temporoparietal fascial graft was one of limited options for rapid wound coverage of extensive wounds with full thickness tissue loss, and failed flaps or grafts. Integra™ Bilayer Matrix Wound Dressing ([BMWD] Integra LifeSciences, Plainsboro, NJ) is another option for extensive wounds and failed flaps or grafts. It is an advanced wound care device comprised of a porous matrix of cross-linked bovine collagen and glycosaminoglycan, and a semipermeable polysiloxane (silicone) layer. The semipermeable silicone membrane controls water vapor loss, provides a flexible adherent covering for the wound surface, and adds increased tensile strength to the device. The collagen-glycosaminoglycan biodegradable matrix provides a scaffold for cellular invasion and capillary growth.³ The BMWD is placed in a clean, debrided wound bed, stapled in place and after about 21 days, the silastic top is removed and a split-thickness skin graft is placed.³
Data suggests that the use of this BMWD accelerates wound closure and improves chances of successful outcome. Burn wounds treated with BMWD progress to healing with less scar formation and a higher rate of success compared to epidermal autografting alone.⁴ The authors of a large, multicenter trial of BMWD for patients with extensive burns defined their study endpoint as the percentage of the area originally covered by BMWD that develops vascularization and sufficient anchorage to support epidermal growth. The mean percentage rate in this study was 76.2% at all burn wound sites and the median rate was 98%. The mean take rate for thin epidermal autograft placed over the BMWD was 87.7% in this study and the median was 95%.⁴
A small, randomized clinical trial also suggests that the use of BMWD combined with negative pressure therapy improves wound healing outcomes.⁵ This study assigned 6 patients to conventional treatment with BMWD and 6 patients to BMWD plus fibrin glue and negative pressure therapy (V.A.C.® Freedom®, KCI, San Antonio, Tex). This comparison demonstrated a take rate of 78% in the conventional group versus 98% in the BMWD plus fibrin glue and negative pressure therapy. In addition, the mean period from BMWD placement to readiness for split-thickness skin grafting was 24 days in the conventional group and 10 days in the BMWD plus fibrin glue and negative pressure therapy.⁵