Yano Tomoyuki, Tanaka Kentaro, Kishimoto Seiji, Iida Hideo, Okazaki Mutsumi
Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
J Craniofac Surg. 2011 Mar;22(2):482-5. doi: 10.1097/SCS.0b013e318207b714.
Owing to changes in the treatment of skull-base tumors, such as perioperative radiotherapy and advances in approaching the skull base, the use of pericranial flaps should be reconsidered. Therefore, we reviewed the reliability of and indications for pericranial flaps in 26 cases in terms of patient background, the effects of preoperative and postoperative treatment, and the pattern of blood circulation. Flaps were harvested as 25 anteriorly based and 4 laterally based. As a result, postoperative complications were observed in 4 patients. No other risk factors, except for heavy smoking, were observed relative to patient background. Sixteen patients had perioperative radiotherapy, and complication rate was significantly higher in patients with preoperative radiotherapy than patients without preoperative radiotherapy (P=0.014). However, no complications, such as cerebral spinal fluid leakage and intracranial infection, were observed in patients receiving postoperative radiotherapy. Laterally based pericranial flaps had a high complication rate (25%), but it was not significantly higher than anteriorly based flaps (P=0.467). Five anteriorly based flaps were harvested with less feeding vessels as usual because of applying dismasking flap approach, but it did not lead to increasing in complication rate. We conclude that a pericranial flap can be used for skull base reconstruction even if postoperative radiotherapy is planned but might be avoided for patients who have received preoperative radiotherapy. In addition, particular care and flap design should be taken to preserve sufficient vascularity when pericranial flaps are raised as laterally based and less feeding vessels as usual.
由于颅底肿瘤治疗方法的改变，如围手术期放疗以及接近颅底技术的进步，应重新考虑使用颅骨膜瓣。因此，我们从患者背景、术前和术后治疗效果以及血液循环模式等方面，回顾了26例患者使用颅骨膜瓣的可靠性和适应证。所取的皮瓣中，25例为前蒂型，4例为侧蒂型。结果，4例患者出现术后并发症。相对于患者背景，除重度吸烟外未观察到其他危险因素。16例患者接受了围手术期放疗，术前放疗患者的并发症发生率显著高于未接受术前放疗的患者（P = 0.014）。然而，接受术后放疗的患者未观察到脑脊液漏和颅内感染等并发症。侧蒂颅骨膜瓣的并发症发生率较高（25%），但并不显著高于前蒂皮瓣（P = 0.467）。由于采用了脱套皮瓣技术，5例前蒂皮瓣按常规获取的供血血管较少，但这并未导致并发症发生率增加。我们得出结论，即使计划进行术后放疗，颅骨膜瓣仍可用于颅底重建，但对于接受过术前放疗的患者可能应避免使用。此外，当采用侧蒂且按常规获取的供血血管较少的方式掀起颅骨膜瓣时，应特别注意并精心设计皮瓣，以保留足够的血供。
