Canadian Ukraine Surgical Aid Program—Resurrection of the Temporalis Muscle Flap in War Injuries

BACKGROUND: The Canadian Ukraine Surgical Aid Program (CUSAP) was established to provide reconstructive craniofacial care to victims of war injuries in Ukraine. Operating under mission constraints-limited resources, staged follow-up by local surgeons, multidrug-resistant infections, and absent preoperative imaging or operative history-demands reconstructive techniques that are reliable, technically accessible, and manageable postoperatively without specialized equipment. OBJECTIVE: To describe the anatomy, surgical technique, and versatile clinical applications of the temporalis muscle flap in the reconstruction of severe war-related craniofacial injuries encountered during a CUSAP surgical mission to Poland in September 2022. METHODS: The authors present 4 cases of severe ballistic and blast craniofacial trauma treated using the temporalis muscle flap. Surgical technique, including flap elevation, zygoma osteotomy, and closure, is described in detail, along with strategies to prevent and manage donor-site temporal hollowing. RESULTS: The temporalis muscle flap was successfully used across a range of reconstructive indications: globe support and orbital floor reconstruction, obliteration of midface dead space, nasal lining, oral-nasal fistula repair, skull base coverage, and a split-flap dynamic sling for oral competence. All flaps provided reliable vascularized soft-tissue coverage, and postoperative management was successfully transitioned to local Ukrainian surgeons. CONCLUSIONS: The temporalis muscle flap remains an invaluable, technically feasible reconstructive option for complex craniofacial war injuries, particularly in resource-limited and time-sensitive surgical mission settings where free tissue transfer is impractical. Its versatility, ease of teaching, and low equipment burden make it a critical tool for global surgical education and reconstruction in the setting of armed conflict.