Correction of temporo-masseteric contour deformity using the dual paddle thoracodorsal artery perforator adiposal flap

In cases of facial asymmetry with denervation atrophy of the masticatory muscles associated with head and neck tumors involving the trigeminal nerve, facial contour depression occurs selectively over the temple and masseteric area, separated by an uninvolved area over the zygomatic arch. The authors developed a new thoracodorsal artery perforator flap with two separate adiposal paddles based on their own perforators from the same mother vessel, the thoracodorsal vessel. Nearly normal temporo-masseteric contour was achieved in two patients. By freely positioning two adiposal paddles supplied by independent perforators based on the same vessel, separate non-contiguous regions of the face could be reconstructed correctly with one microvascular anastomosis in a single-stage operation, without the need for a secondary procedure to reduce the bulk over the zygomatic arch.