Anatomy and blood supply of the subgaleal fascia flap.

The subgaleal fascia (SGF) is a distinct layer in the temporal fossa situated between the superficial fascia and galea aponeurotica and the temporal fascia covering the superficial surface of the temporal muscle. The SGF is used most frequently for otologic reconstruction. Reviewing the literature, however, showed many contradictory findings about dissection of an independent SGF layer, its blood supply, and the possibility of harvesting it as part of a combined flap. Our study, carried out on ten fresh cadavers, presents a detailed view of the blood supply of the SGF to develop a safe method of harvesting an inferior-based SGF. Our systematic plane-by-plane approach, associated with a transparent grid applied on each dissection, allowed us to quantify the branches from each plane and to localize precisely their entering sites from a reference "zygomatic point." The SGF had no ascending axial vascular supply entering from its base; according to our results, therefore, the SGF could not be harvested alone as an inferior pedicled flap down to the zygomatic arch. It may be feasible, however, to harvest a SGF flap when a strip of the superficial fascia is associated with its middle third. Therefore, we suggest that an average height of 5.4 cm of superficial fascia should be included in an inferior-based pedicle of a SGF. Copyright 2004 Wiley-Liss, Inc.