Schwartz M S, Cohen J I, Meltzer T, Wheatley M J, McMenomey S O, Horgan M A, Kellogg J X, Delashaw J B
Department of Neurosurgery, Oregon Health Sciences University, Portland, USA.
J Neurosurg. 1999 Apr;90(4):651-5. doi: 10.3171/jns.1999.90.4.0651.
Reconstruction of the cranial base after resection of complex lesions requires creation of both a vascularized barrier to cerebrospinal fluid (CSF) leakage and tailored filling of operative defects. The authors describe the use of radial forearm microvascular free-flap grafts to reconstruct skull base lesions, to fill small tissue defects, and to provide an excellent barrier against CSF leakage.
Ten patients underwent 11 skull base procedures including placement of microvascular free-flap grafts harvested from the forearm and featuring the radial artery and its accompanying venae comitantes. Operations included six craniofacial, three lateral skull base, and two transoral procedures for various diseases. Excellent results were obtained, with no persistent CSF leaks, no flap failures, and no operative infections. One temporary CSF leak was easily repaired with flap repositioning, and at one flap donor site minor wound breakdown was observed. One patient underwent a second procedure for tumor recurrence and CSF leakage at a site distant from the original operation.
Microvascular free tissue transfer reconstruction of skull base defects by using the radial forearm flap provides a safe, reliable, low-morbidity method for reconstructing the skull base and is ideally suited to "low-volume" defects.
切除复杂病变后重建颅底需要建立一个防止脑脊液（CSF）漏的带血管屏障，并对手术缺损进行定制填充。作者描述了使用桡侧前臂游离微血管皮瓣移植来重建颅底病变、填充小组织缺损以及提供防止脑脊液漏的良好屏障。
10例患者接受了11次颅底手术，包括植入从前臂获取的以桡动脉及其伴行静脉为特征的游离微血管皮瓣移植。手术包括6例颅面手术、3例侧颅底手术和2例经口手术，针对各种疾病。结果良好，无持续性脑脊液漏、皮瓣无失败、无手术感染。1例暂时性脑脊液漏通过皮瓣重新定位轻松修复，1个皮瓣供区观察到轻微伤口裂开。1例患者因肿瘤复发和远离原手术部位的脑脊液漏接受了第二次手术。
使用桡侧前臂皮瓣进行微血管游离组织转移重建颅底缺损为重建颅底提供了一种安全、可靠、低发病率的方法，非常适合“小体积”缺损。
