Pseudoaneurysm arising from the superficial temporal artery (STA) is very rare and is most commonly caused by blunt trauma. Most pseudoaneurysms of the STA usually present as a painless pulsating mass, with concomitant symptoms according to location, and their size may rapidly increase. The treatment of choice is ligation and resection. We present a case of pseudoaneurysm arising from STA after a penetrating injury caused by broken glass. We describe the history, findings of physical examination, Doppler sonography, angiography, histopathology, and the outcome of treatment. We also include a brief review of this condition.
Aneurysm, False/surgery ; Aneurysm, False/etiology* ; Aneurysm, False/diagnosis ; Angiography, Digital Subtraction ; Case Report ; Human ; Male ; Middle Age ; Temporal Arteries/surgery ; Temporal Arteries/pathology ; Temporal Arteries/injuries* ; Thrombosis/etiology ; Ultrasonography, Doppler ; Wounds, Penetrating/surgery ; Wounds, Penetrating/complications*

OBJECTIVETo study the course of branches of the superficial temporal artery (BSTA) and the accompanying pattern of their veins in order to provide anatomic basis for flap design.

METHODSHead and facial part of ten adult corpses (19 sides) were dissected and photographed. The coordinate system was set up with external auditory foramen as the point of origin, aided by the graph analysis software Digimizer. The course of the frontal branch and parietal branch of the superficial temporal artery (STA), and the accompanying pattern between the BSTA and the veins were measured and analyzed. The STA and its branches were located by Ultrasonic Doppler, and the corresponding branches of the superficial temporal vein (BSTV) were disclosed by bowing patient's head with breath holding or cerclaging the basement of the patient's skull. And then 10 sides of transposition (fascia) flaps with axis at the angular bisector between BSTA and BSTV were devised to repair wounds of 9 patients that hospitalized from February 2008 to December 2009. Data were processed with test of variance homogeneity.

RESULTSFrontal BSTV absence was found in 6 head sides, and the maximum distance between artery and vein was (2.1 ± 1.2) cm. Parietal BSTV absence was found in 3 head sides, and the maximum distance was (1.4 ± 0.7) cm. The distance between frontal BSTA and BSTV was larger than that between parietal BSTA and BSTV, and the dispersion degree of the former was higher than that of the latter (F = 0.0404, P = 0.0475). All the (fascia) flaps survived without congestion or necrosis.

CONCLUSIONSWhen branch of the superficial temporal vessel was selected as the axial vessel of flap, the flap design shall depend on the accompanying pattern of BSTV to avoid the flap necrosis due to poor venous return after surgery. The superficial temporal vein and its branches can be well disclosed by bowing head or cerclaging skull. The approach is simple, useful, safe, and reliable.

Adult ; Humans ; Male ; Surgical Flaps ; blood supply ; Temporal Arteries ; anatomy & histology ; surgery ; Veins ; anatomy & histology ; surgery

Brain Infarction ; surgery ; Brain Ischemia ; surgery ; Cerebral Revascularization ; Humans ; Middle Cerebral Artery ; surgery ; Postoperative Period ; Retrospective Studies ; Temporal Arteries ; surgery

OBJECTIVEA reversed superficial temporal artery auricular flap was presented to explore a new method for reconstructing the defects of the distal nose by microsurgical techniques.

METHODSA reversed superficial temporal artery auricular flap had been used on fifteen patients with nasal defects, including thirteen patients with alar defects and two patients with nasal tip defects. The reversed superficial temporal vessels of the flap were anastomosed with the recipient facial vessels. The size of the flap was 2.5 cm x 2. 0 cm - 4.0 cm x 2.5 cm, the length of the vascular pedicle was 5 - 8 cm, average 6.5 cm

RESULTSThe flap survived uneventfully in all fifteen patients.

RESULTSdemonstrated satisfactory symmetry between the reconstructed ala and the contralateral side as well as an excellent tip projection. The donor-site defect was minimal.

CONCLUSIONSThe reversed superficial temporal artery auricular flap offers an adequate length of vascular pedicle of the flap, it delivers a good solution to the problem of the vascular pedicle shortage of the proximal superficial artery auricular flap. This technique may become the top choice in the microvascular auricular transfer.

Adult ; Ear, External ; surgery ; Female ; Humans ; Male ; Middle Aged ; Nose ; surgery ; Nose Deformities, Acquired ; surgery ; Rhinoplasty ; methods ; Surgical Flaps ; blood supply ; Temporal Arteries ; surgery ; Tissue Transplantation ; Young Adult

OBJECTIVEThis article reports the design and application of a free reverse preauricular flap for one-stage reconstruction of nasal defects.

METHODSA preauricular flap was designed according to the nasal defect, which was harvested with the reverse superficial temporal vessels as its vascular pedicle. The flap size ranged from 3.0 cm x 2.5 cm to 6 cm x 2 cm without any hair-bearing skin. In flap transferring, its pedicle of the superficial temporal vessels was anastomosed with the facial vessels in the nasolabial fold.

RESULTSThe flap survived uneventfully in these three patients. The defects in the distal nose were reconstructed with satisfactory results. The donor site scar was similar to that of face-lift incision.

CONCLUSIONSThis is the first report of clinical applications of the free reverse preauricular flap by microsurgical technique. Microsurgical technique allows successful transfer of this flap in a one-stage procedure. Because of its similar color and texture to the facial skin, this flap provides excellent tissues for coverage of the nasal defect. This technique may have even wider applications for other facial cutaneous defects.

Adult ; Ear, External ; surgery ; Female ; Humans ; Male ; Microsurgery ; Nose Deformities, Acquired ; surgery ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Surgical Flaps ; blood supply ; Temporal Arteries ; surgery ; Young Adult

OBJECTIVETo investigate the application of forward and reversal flow axial island flap in the orbital skin defects.

METHODSAccording to the distribution of superficial temporal artery as well as the anastomoses with the branches of supraorbital artery and supratrochlear artery, etc, the frontal, scalp, preauricular and postauricular island flaps were designed. The flaps were displaced through subcutaneous tunnel to cover all kinds of orbital skin defects.

RESULTS13 cases of forward flow flap and 9 of reversal flow flap out of 22 cases in all were observed. One postauricular reversal flow axial island flap showed the obstruction of venous refluence in early postoperative stage, however, after active treatment, mere the distal epidermal necrosis was revealed. There were six re-operations on the postoperative flap hypertrophy. The others were in good shape and functional state.

CONCLUSIONSThe superficial temporal artery is one of most vital blood supply in the upper face. It has wide anastomoses with the supraorbital artery and supratrochlear artery. As the colors and the nature of the frontal, preauricular and post auricular skin are close to orbital skin, the application of forward and reversal flow axial island flap based on the superficial temporal artery can be used in the reconstruction of all kinds of orbital skin defects.

Adolescent ; Adult ; Child ; Eyelids ; abnormalities ; surgery ; Female ; Humans ; Male ; Orbit ; abnormalities ; surgery ; Skin Transplantation ; methods ; Surgical Flaps ; blood supply ; Temporal Arteries ; surgery ; Young Adult

OBJECTIVETo evaluate a retro-grade auricular flap for repairing large alar defects.

METHODSTwenty-nine adult cadavers were anatomically used for vascular investigation of the frontal, nasal and temporal regions by injecting a dye into the main vessels. Based on the anatomical study in these regions, a retro-grade auricular flap was designed for repairing alar defects in 16 patients.

RESULTSThe blood supply of the auricle could be nourished by the inner carotid artery system from the supratrachlear artery and supraorbital artery through the frontal arterial anastomotical network into the frontal branch of the superficial temporal artery. It is then passing the main trunk of the superficial temporal artery into the ear area through the auricular branches of the superficial temporal artery. The retro-grade auricular island flap could be formed by basing the supratrachlear artery and the supraorbital artery through the vascular network between the superficial temporal artery and the supratrachlear artery or the supraorbital artery. Sixteen patients with large alar defects and half-sized nasal defects were successfully repaired by this technique.

CONCLUSIONSThe retro-grade auricular island flap, based on the inner carotid artery system, could be a good and safe flap for repairing a large alar defect or half-sized nasal reconstruction.

Adult ; Arteries ; Cadaver ; Carotid Artery, Internal ; Ear Auricle ; blood supply ; Humans ; Nose Deformities, Acquired ; surgery ; Ophthalmic Artery ; Reconstructive Surgical Procedures ; Surgical Flaps ; blood supply ; transplantation ; Temporal Arteries

OBJECTIVETo investigate the application of reverse island auricular composite tissue flap based on the superficial temporal artery for alar defects.

METHODS16 cases with alar defects were treated with reverse island auricular composite tissue flap based on the superficial temporal artery.

RESULTSAll the composite auricular flaps survived with primary healing. The patients were followed up for half a year to four years. The survived composite flaps had a similar color, texture and appearance as normal alar. The cosmetic result was satisfactory.

CONCLUSIONSReverse island auricular composite tissue flap based on the superficial temporal artery is very suitable for alar defects.

Adult ; Ear, External ; transplantation ; Female ; Humans ; Male ; Middle Aged ; Nose Deformities, Acquired ; surgery ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; Surgical Flaps ; blood supply ; Temporal Arteries ; surgery ; Young Adult

BACKGROUNDIntra-cerebral hemorrhage (ICH) is a devastating complication that can result from superficial temporal artery-middle cerebral artery (STA-MCA) bypass in patients undergoing treatment for steno-occlusive cerebrovascular disease (CVD). There is a clinical need to find the possible risk factors to prevent ICH, as it is a significant cause of mortality and morbidity. The aim of the study was to investigate the factors associated with delayed ICH after STA-MCA bypass in patients with steno-occlusive CVDs.

METHODSWe retrospectively analyzed the records of 163 patients seen from 2002 to 2011 with STA-MCA bypass for steno-occlusive cerebrovascular diseases at the Department of Neurosurgery, Xuan Wu Hospital, Beijing. Demographic and clinical data, including age, gender, vascular risk factors, preoperative syndrome, preoperative National Institutes of Health Stroke Scale (NIHSS), ipsilateral ischemic lesions, classification of steno-occlusive CVDs, donor branches of STA, graft patency, postoperative hypertension, and postoperative-increased MCA velocity were recorded and analyzed. Binary Logistic regression served to identify factors associated with delayed ICH after STA-MCA bypass.

RESULTSWe identified 8 (4.9%) patients with delayed ICH after STA-MCA bypass. Patients with hypertension, preoperative stroke, ipsilateral ischemic lesions, postoperative hypertension and postoperative-increased MCA velocity were significantly more prone to experiencing delayed ICH after STA-MCA bypass. Logistic regression analysis shows ipsilateral ischemic lesions, postoperative hypertension, and postoperative-increased MCA velocity remained independent predictors for delayed ICH after STA-MCA bypass.

CONCLUSIONDespite the varied associated factors in patients with steno-occlusive CVDs, ipsilateral ischemic lesions, postoperative hypertension, and postoperative-increased MCA velocity could be associated with delayed ICH after STAMCA bypass.

Adult ; Cerebral Hemorrhage ; etiology ; Cerebral Revascularization ; Female ; Humans ; Male ; Middle Cerebral Artery ; surgery ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Temporal Arteries ; surgery

OBJECTIVETo study the feasibility of applying expanded forehead axial flaps with fascia pedicles carrying bilateral frontal branches of superficial temporal artery and vein (expanded forehead axial flap with double pedicles in brief, EFAF-DP) in repairing scars in submaxillary region.

METHODSSixteen patients with mandibular scars hospitalized in Department of Burns and Plastic Surgery of the First Hospital Affiliated to Fuzhou General Hospital in Nanjing Military Area Command from July 2005 to December 2009 were repaired with EFAF-DP. The operation consisted of 3 stages. Before operation, the location and course of superficial temporal arteries and veins (STAV) and their frontal and parietal branches were identified with Ultrasonic Doppler blood flow detector. In stage I, STAV were dissected from the frontalis muscle as a pedicle to form a skin soft tissue space to hold the dilator of a proper size. In stage II, after gradual dilation by repeated filling with saline, the dilator was removed. EFAF-DP was dissected to repair mandibular scar. Donor site was closed with sutures. In stage III, flap pedicles were divided and pruned.

RESULTSFlap sizes ranged from 25 cm × 6 cm to 33 cm × 16 cm. The duration of dilation was 3-5 months, with 3.6 months in average. Ten patients underwent the operation of EFAF-DP transplantation and cervical skin dilatation. All flaps survived with healing of wounds. Disorder of venous return at the distal end of one flap was seen after second stage surgery, and it was corrected after comprehensive treatment including relieving spasm and improving venous return. Donor site wounds healed with normally grown hair without cicatricial alopecia along the hairline. Few hairs grew around mandible in one female patient out of the three (no hair grew on flaps of other two patients). This female patient and two male patients requesting for beard plasty received laser depilation treatment 1 to 3 months after discharge, with good result. Other male patients received no special treatment for their beard, and they shaped their beard with shaver. Sixteen patients were followed up for 6 to 24 months, and the shape of the flaps and beard (excluding female patients) were satisfactory with good appearance, satisfactory skin color and texture. The mobility of neck was obviously improved.

CONCLUSIONSEFAF-DP provides bigger areas of a thin flap besides promoting vascularization of new vessels of flap. Extra expanded skin can be directly sutured at the fringe of hairline, which makes skin grafting unnecessary, and decreases the incidence of secondary deformity in donor sites. Some hair carried by the flaps can be directly used for beard reconstruction after rotation to help the male patients have a better appearance.

Adolescent ; Adult ; Cicatrix ; surgery ; Female ; Humans ; Male ; Surgery, Plastic ; methods ; Surgical Flaps ; blood supply ; Temporal Arteries ; transplantation ; Tissue Expansion ; Veins ; transplantation ; Young Adult