Superficial temporal artery perforator flap: anatomic study of number and reliability of distal branches of the superficial temporal artery and clinical applications in three cases

Background: Limited information is available about the anatomical feasibility and clinical applications of flaps based on distal divisions of the superficial temporal artery (STA). The aim of this study was to investigate the anatomy of the STA, focusing on the number and reliability of distal branches and to show representative cases for the use of such flaps for zygomatic, parieto-frontal and occipital reconstructions. Methods: Fifty volunteers were examined bilaterally by Doppler to investigate the presence and variability of the distal divisions of STA branches. Dissection was performed on 14 temporal regions of 7 fresh cadavers. Three cases of reconstruction following skin cancer in the zygomatic (7 × 5 cm defect), parieto-frontal (4 × 4 cm defect) and occipital areas (4 × 2 cm defect) are presented. All the flaps were pedicled and based on a single vessel. Results: In all the 50 volunteers, the parietal branch split into 2 ± 0 branches (anterior and posterior), bilaterally, while an average of 2.84 ± 0.46 and 2.82 ± 0.48 branches originated from the frontal vessel on the right and left side, respectively. 2 ± 0 parietal and 3 ± 0 frontal (superior, central, and inferior) cutaneous perforator branches were identified in all cadaveric specimens. Flaps (4 × 10 cm, 5 × 7 cm, and 2 × 5 cm, respectively, width × length) healed uneventfully providing stable coverage. Conclusions: STA distal perforator branches proved to be anatomically constant in both the cadaveric and clinical settings. Although a larger series of cases is needed, island flaps based on such vessels may represent a versatile surgical option, allowing a wide range of reconstructions in the different facial subunits.