Malata Charles M, Tehrani Hamid, Kumiponjera Devor, Hardy David G, Moffat David A
Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, England.
Ann Plast Surg. 2006 Aug;57(2):169-75; discussion 176. doi: 10.1097/01.sap.0000218490.16921.c2.
Lateral skull base defects following tumor ablation are ideally reconstructed with microvascular free tissue transfer. Although the rectus abdominis free flap is the workhorse in skull base reconstruction, it has a number of drawbacks. Anecdotal reports have indicated that fasciocutaneous free flaps may be useful alternatives in selected cases. Patients undergoing lateral arm (4 cases) or anterolateral thigh (8 cases) fasciocutaneous free flap reconstruction of lateral skull base defects between 1999 and 2005 were therefore reviewed. Twelve consecutive patients (4 males, 8 females) with a mean age of 63 years (range, 39 to 74) underwent such reconstruction following resection of lateral (11 cases) and anterolateral (1 case) skull base lesions. Eight patients had squamous cell carcinoma, 3 had infection or osteoradionecrosis, and 1 had adenoid cystic carcinoma. The duration of surgery (from induction of anesthesia to exit from the operating room) averaged 14.5 hours (range, 10 to 19.5 hours). All donor sites were closed directly. All the flap transfers were successful, with minimal reconstructive and donor site morbidity. During the follow-up period (average, 18 months; range, 2-48 months), 2 patients died of metastatic disease, and another 2 died of other unrelated causes. The remaining 8 patients are alive and disease free. It is concluded that lateral arm and anterolateral thigh fasciocutaneous free flaps should be considered as viable reconstructive options for lateral skull base ablative defects.
肿瘤切除术后的侧颅底缺损理想情况下应采用游离微血管组织移植进行重建。尽管腹直肌游离皮瓣是颅底重建的常用方法，但它有许多缺点。轶事报道表明，在某些特定情况下，筋膜皮瓣游离皮瓣可能是有用的替代方案。因此，回顾了1999年至2005年间接受侧臂（4例）或股前外侧（8例）筋膜皮瓣游离皮瓣重建侧颅底缺损的患者。连续12例患者（4例男性，8例女性），平均年龄63岁（范围39至74岁），在切除侧颅底（11例）和前外侧颅底（1例）病变后接受了此类重建。8例患者患有鳞状细胞癌，3例患有感染或放射性骨坏死，1例患有腺样囊性癌。手术时间（从麻醉诱导到手术室出院）平均为14.5小时（范围10至19.5小时）。所有供区均直接缝合。所有皮瓣移植均成功，重建和供区并发症极少。在随访期间（平均18个月；范围2至48个月），2例患者死于转移性疾病，另外2例死于其他无关原因。其余8例患者存活且无疾病。结论是，侧臂和股前外侧筋膜皮瓣游离皮瓣应被视为侧颅底切除术后缺损可行的重建选择。
