Urken M L, Catalano P J, Sen C, Post K, Futran N, Biller H F
Department of Otolaryngology, Mount Sinai School of Medicine, New York, NY 10029, USA.
Arch Otolaryngol Head Neck Surg. 1993 Dec;119(12):1318-25. doi: 10.1001/archotol.1993.01880240054007.
The role of free flaps in skull base reconstruction is discussed in detail. Twenty-six microvascular free tissue transfers performed in 22 patients are reviewed in detail. A classification scheme for skull base defects is presented.
Tertiary referral center.
Twenty-two patients with neoplasms that involve the skull base underwent a combined craniotomy and facial approach for resection. The resultant defects were reconstructed with a variety of microvascular free flaps.
All 22 patients were ultimately successfully reconstructed with a free flap. One patient required a second free flap following ablative surgery for a recurrent tumor. The initial free flaps in three patients were unsuccessful and a second flap was required. The classification scheme was applied to all defects.
The creation of a functional separation of the intracranial and extracranial cavities can be extremely difficult to accomplish, especially when multiple cavities (nasal, oral, pharyngeal) are violated. Free flaps provide a solution to this problem in select cases. Skull base defects can and should be classified for the purpose of communication, treatment planning, prognosis of reconstruction, and judging therapeutic outcome.
详细讨论游离皮瓣在颅底重建中的作用。详细回顾了22例患者接受的26例微血管游离组织移植手术。提出了一种颅底缺损的分类方案。
三级转诊中心。
22例累及颅底的肿瘤患者接受了开颅和面部联合手术切除。用各种微血管游离皮瓣修复由此产生的缺损。
所有22例患者最终均成功用游离皮瓣重建。1例患者在复发性肿瘤切除术后需要第二次游离皮瓣。3例患者的初始游离皮瓣未成功，需要第二次皮瓣。分类方案应用于所有缺损。
实现颅内和颅外腔的功能分离极其困难，尤其是当多个腔隙（鼻腔、口腔、咽腔）受累时。游离皮瓣在特定情况下为该问题提供了解决方案。为了交流、治疗计划、重建预后和判断治疗结果，颅底缺损可以且应该进行分类。
