Superficial temporal artery perforator flap: an anatomical study and topographic mapping of cutaneous perforators

The superficial temporal artery perforator (STAP) flap is an emerging option for facial reconstruction, yet no topographic map of the cutaneous perforators of the superficial temporal artery (STA) exists. We aimed to map the origins of clinically relevant perforators (diameter ≥0.5 mm). Twenty-five STA territories from 14 fresh cadaveric specimens were dissected after intra-arterial injection (22 latex-neoprene, 3 India ink). A two-axis cutaneous reference frame was traced on each hemiface (x-axis: tragus-lateral canthus line; y-axis: perpendicular through its midpoint). A hemiscalp flap was raised through Merkel's space; each perforator was identified on its deep aspect, photographed, measured (ImageJ), localized in a bifurcation-centered frame, and used to generate a two-dimensional kernel-density map. A bifurcation was found in 24 of 25 hemiheads (96%), supra-zygomatic in 80%, lying roughly two finger-breadths anterior and superior to the tragus. Among 108 perforators, the frontal branch was dominant (2.54 ± 0.59 per STA): its horizontal segment carried ≥1 perforator in 100% (mostly glabrous skin), its vertical segment ≥1 in 67% (mostly hair-bearing). The parietal branch carried 1.96 ± 0.69 perforators (≥1 in 96%; hair-bearing). STA cutaneous perforators are constant and reproducibly distributed. This map may aid preoperative Doppler localization and the design of glabrous or hair-bearing STAP flaps.