Surgical Anatomy of the Scalp: Technical Hints for Harvesting the Temporoparietal Fascial and Pericranial Flap

INTRODUCTION: Scalp flaps are a cornerstone in skull base (SB) reconstruction thanks to their rich vascularization, large volume, and extra-nasal location. Among them, the pericranial flap (PF) and temporoparietal fascial flap (TPFF) are the most frequently applied. However, in the majority of cases, they result in being mutually exclusive based on the standard surgical technique to harvest them. The aim of this manuscript is to validate the concept of anatomical and thus surgical independence between the TPFF and PF through the analysis of topographic anatomy and description of challenging cases in which these scalp flaps were used. METHODS: In this multicentric retrospective study, we have selected cases of SB reconstruction with TPFF and/or PF, for which the independence of underlying vascular and topographic anatomy has been exploited. Three different scenarios were encountered: (1) TPFF harvested after a coronal approach; (2) PF harvested with preservation of the TPFF pedicle; (3) Simultaneous harvesting of TPFF and PF. Data on surgical morbidity and outcomes were collected. RESULTS: None of the 5 patients included in the study experienced flap or scalp necrosis, or perioperative adverse events, thus supporting the independent viability (or vascularization) of the 2 flaps. In all cases, an adequate SB reconstruction was achieved. CONCLUSION: The TPFF and PF are SB reconstructive solutions that can be applied independently thanks to their anatomical and vascular structure. This evidence expands the applicability and versatility of these regional flaps.