What should be done if an anterior temporalis flap cannot be felt or does not have a detectable pulse?

When an anterior temporalis flap lacks a detectable pulse or cannot be felt, this indicates possible vascular compromise, meaning the flap may be at risk for necrosis. Choosing to discard the flap and use a new posterior temporalis flap is a prudent approach. The posterior temporalis flap, which is based on different vascular supplies, offers an alternative that ensures better viability due to its more reliable blood flow.

While repositioning the flap and observation could be considered in some cases, if there is no pulse indication, waiting might lead to complications that can significantly affect healing and patient outcomes. Adding additional sutures may provide stability but will not address the fundamental concern of the flap's viability. Conducting another Doppler ultrasound may be useful in certain situations to evaluate blood flow again; however, it would not resolve the immediate concern about vascular supply.

In this case, opting for a new flap entirely is the most definitive solution to avoid potential failure of the ischemic tissue.