Kiyokawa K, Tai Y, Inoue Y, Tanabe H Y, Hayakawa K, Mori K, Hirano M, Shigemori M, Tokutomi T
Department of Plastic and Reconstructive Surgery, Kurume University School of Medicine, Japan.
Scand J Plast Reconstr Surg Hand Surg. 2000 Mar;34(1):43-53. doi: 10.1080/02844310050160169.
Since March 1988 the temporal musculopericranial (TMP) flap has been used as our flap of choice to reconstruct defects of the anterior base of the skull that are larger than 2 x 3 cm, including the dura mater, in 33 patients. The primary diseases were malignant head and neck tumours (n = 16), trauma (n = 15), meningioma (n = 1), and teratoma (n = 1). The dura mater was reconstructed with a unilateral TMP flap, after which the cranial and nasal cavities were closed with the opposite TMP flap. In addition, bone was grafted by sandwiching the bone between the two flaps and fixing it to the surrounding residual bone. When a large area was resected, making it impossible to use a TMP flap, a frontal musculopericranial (FMP) flap or a free flap (usually the rectus abdominis myocutaneous flap) was used to close the cranial and nasal cavities. Thirty of the 33 patients recovered with no postoperative complications. Two patients developed extradural abscesses in the anterior base of the skull and one developed mild meningitis, but they were successfully treated conservatively. When bilateral TMP flaps were used for the reconstruction, no patient had aesthetic problems in the forehead region. The TMP flap is extremely effective for the reconstruction of the anterior base of the skull because it is minimally invasive and causes few aesthetic problems in the forehead region.
自1988年3月以来，颞肌-帽状腱膜（TMP）瓣一直被用作我们首选的皮瓣，用于重建33例颅骨前基底部大于2×3 cm的缺损，包括硬脑膜。原发性疾病为头颈部恶性肿瘤（n = 16）、创伤（n = 15）、脑膜瘤（n = 1）和畸胎瘤（n = 1）。用单侧TMP瓣重建硬脑膜，然后用对侧TMP瓣封闭颅腔和鼻腔。此外，通过将骨夹在两个皮瓣之间并将其固定在周围残留骨上来植骨。当切除大面积组织而无法使用TMP瓣时，则使用额肌-帽状腱膜（FMP）瓣或游离皮瓣（通常为腹直肌肌皮瓣）来封闭颅腔和鼻腔。33例患者中有30例康复，无术后并发症。2例患者在颅骨前基底部发生硬膜外脓肿，1例发生轻度脑膜炎，但经保守治疗均成功治愈。当使用双侧TMP瓣进行重建时，没有患者在前额区域出现美观问题。TMP瓣对颅骨前基底部的重建极为有效，因为它微创且在前额区域几乎不会引起美观问题。
