Superficial Temporal Artery Perforator (STAP) Flaps for Intraoral Defects: Technique and Flap Design
Jerette J. Schultz, M.D., Stephen L. Viviano, M.D., Paul J. Therattil, M.D., Jonathan D. Keith, M.D..
Rutgers New Jersey Medical School, Newark, NJ, USA.
Background: Intraoral defects after tumor resection are often reconstructed with free flaps. However, regional flaps based on the superficial temporal artery can be useful in patients who are not good candidates for free tissue transfer. Flaps based on the anterior branch of the superficial temporal artery have been previously described. Here, we present our novel technique to reconstruct intraoral defects with the superficial temporal artery perforator (STAP) flap either based on the anterior or posterior branch. The choice of which perforator to use was based on preoperative planning with external Doppler, SPY angiography, and FLIR thermal imaging.
Methods: A retrospective chart review was performed for STAP flaps used for intraoral defects by a single surgeon. External doppler, intraoperative indocyanine green laser angiography, and FLIR thermal imaging were used preoperatively to identify the best perforators and plan for flap design. The skin paddles were tunneled in a facelift plane and over the zygoma into the oral cavity for inset (Figure 1).
Results: Three patients underwent superficial temporal artery perforator (STAP) flaps for intraoral defects including the hard palate, buccal sulcus, floor of mouth, and retromolar trigone. All patients had either prior radiation or prior resection and reconstruction, making them poor free flap candidates. The mean age was 76 (71-84) and average follow up was 2 months. There were no flap losses and no donor site complications. One patient had partial flap necrosis that healed after revision in the operating room. Two donor sites were closed primarily, while one required a full thickness skin graft.
Conclusions: The superficial temporal artery perforator flap is a useful regional flap for intraoral defects after tumor resection. The benefits of this flap compared to free flaps are a decreased anesthesia time, less donor site morbidity, and no need for post-operative monitoring. External Doppler, intraoperative indocyanine green laser angiography, and FLIR thermal imaging are useful modalities to find the best perforators to design the flap.
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