Amin Ayman, Rifaat Mohammed, Civantos Francisco, Weed Donald, Abu-Sedira Mohammed, Bassiouny Mahmoud
Department of Surgical Oncology, National Cancer Institute, Cairo University, Egypt.
J Reconstr Microsurg. 2006 Feb;22(2):97-104. doi: 10.1055/s-2006-932503.
Free-tissue transfer has revolutionized skull-base surgery by expanding the ability to perform cranial base resection and by improving the quality of reconstruction. The anterolateral thigh flap has come recently into use in the field of head and neck reconstruction. Its role in craniofacial and midface reconstruction has not been specifically defined. This study involved a total of 18 patients who were treated over a 5-year period from 1998 to 2003. Seventeen patients had locally advanced head and neck cancer, requiring craniofacial resection, and one patient had a complicated gun shot wound of the forehead. Thirteen patients were treated at the National Cancer Institute, Cairo University, Egypt, and five patients at the University of Miami, Florida. The patients presented with defects of the anterior skull base (5), lateral skull base (3), scalp and calvarium (3), and the midface (7). The anterolateral thigh flap was used as a myocutaneous flap in 11 cases and as a perforator fasciocutaneous flap in seven cases. Musculocutaneous perforators supplied the majority of flaps (17/18). Total flap survival occurred in 17 cases; one patient developed complete flap necrosis. The most commonly used recipient vessels were the facial vessels and the external jugular vein. Major complications included one case with meningitis; the patient died after failure of treatment. Another patient died 6 weeks postoperatively from pulmonary embolism. One patient developed CSF leak that stopped spontaneously. In addition, two patients developed minor wound dehiscence that healed spontaneously. The donor-site wound healed without problems except in two cases. One patient had an incomplete take of the skin graft; the other developed wound infection and superficial sloughing. Both wounds healed spontaneously. In addition to the feasibility of simultaneous flap harvesting with tumor resection, the flap's advantage in skull base reconstruction is its reliable blood supply, which can provide adequate dural cover and protection of the brain. Its size and moderate thickness are suitable for reconstruction of scalp and calvarial defects. The abundance of reliably vascularized fat in the flap may be an advantage in long-term maintenance of the volume of the flap in midface reconstruction. Similar to other soft tissue flaps, additional skeletal reconstruction may still be required to achieve an optimal functional and aesthetic result.
游离组织移植通过扩大颅底切除能力和提高重建质量，给颅底手术带来了变革。股前外侧皮瓣最近已开始应用于头颈部重建领域。其在颅面和中面部重建中的作用尚未明确界定。本研究共纳入了1998年至2003年5年间接受治疗的18例患者。17例患者患有局部晚期头颈癌，需要进行颅面切除，1例患者前额有复杂枪伤。13例患者在埃及开罗大学国家癌症研究所接受治疗，5例患者在佛罗里达州迈阿密大学接受治疗。患者出现前颅底缺损（5例）、外侧颅底缺损（3例）、头皮和颅骨缺损（3例）以及中面部缺损（7例）。股前外侧皮瓣在11例中用作肌皮瓣，7例中用作穿支筋膜皮瓣。肌皮穿支为大多数皮瓣供血（17/18）。17例皮瓣全部存活；1例患者出现皮瓣完全坏死。最常用的受区血管是面血管和颈外静脉。主要并发症包括1例脑膜炎；患者治疗失败后死亡。另1例患者术后6周死于肺栓塞。1例患者出现脑脊液漏，自行停止。此外，2例患者出现轻微伤口裂开，自行愈合。供区伤口除2例外均顺利愈合。1例患者植皮成活不完全；另1例出现伤口感染和浅表脱落。两个伤口均自行愈合。除了与肿瘤切除同时切取皮瓣的可行性外，该皮瓣在颅底重建中的优势在于其可靠的血供，可提供足够的硬脑膜覆盖并保护大脑。其大小和适中的厚度适合重建头皮和颅骨缺损。皮瓣中丰富的可靠血管化脂肪可能有利于中面部重建中皮瓣体积的长期维持。与其他软组织皮瓣类似，可能仍需要额外的骨骼重建以获得最佳的功能和美学效果。
