[Coverage of post-traumatic brain exposure by a total temporal flap: a case report]

Area of Science:

• Neurosurgery
• Plastic Surgery
• Craniofacial Trauma Reconstruction

Background:

• Penetrating brain injuries often cause major scalp defects, posing significant reconstructive challenges in acute craniofacial trauma.
• While depressed skull fractures with intact skin are manageable with locoregional flaps, extensive skin damage limits options to less ideal local transposition or free flaps.

Observation:

• Free flaps present disadvantages including micro-anastomosis complications, poor vascular status, and aesthetic concerns.
• A clinical case demonstrated the feasibility of a three-stage total temporal flap for combined skin and bone defects.

Findings:

• The described technique involves three distinct surgical stages over 45 days.
• Stage 1: Empowerment of bilateral middle temporal pedicles. Stage 2 (15 days later): Flap sectioning, transposition, and wound coverage. Stage 3 (30 days later): Flap separation.

Implications:

• This staged total temporal flap offers a viable solution for complex scalp and bone defects following penetrating brain injury.
• It provides an alternative to free flaps, potentially improving outcomes in challenging craniofacial trauma cases.