Division of Plastic, Reconstructive, Aesthetic and Hand Surgery, Department of Surgery, University Hospital of Basel, Basel, Switzerland.
Int J Oral Maxillofac Surg. 2011 Sep;40(9):931-7. doi: 10.1016/j.ijom.2011.05.013. Epub 2011 Jun 15.
Free tissue transfer has been the gold standard of extensive skull base reconstruction, but the onlay of free flaps onto skull base defects carries the risk of cerebrospinal fluid (CSF) leakage. The purpose of this study was the evaluation of a novel technique of a combined sub- and onlay concept with a partially intracranially positioned folded free fasciocutaneous flap in terms of flap applicability, versatility and complication rate. Within 5 years, 7 patients with anterior (n=4), middle (n=2) or posterior (n=1) skull base defects were reconstructed with free extended lateral arm (n=3) or anterolateral thigh (n=4) flaps. The flaps were partially intracranially positioned and fixed with osteo-dermal sutures. Both flaps proved to be applicable in terms of sealing efficiency, minimizing intracranial flap volume and folding. No flap loss was observed. Specific complications consisted of one pneumocranium via an accessory frontal sinus and one cerebellar herniation due to lumbar CSF loss. No flap failure or haematoma of the intracranial flap part occurred. This new concept of intracranial positioning of fasciocutaneous flaps in a sandwich technique using osteo-dermal sutures should be considered as a primary treatment for skull base reconstruction rather than merely as a salvage manoeuvre.
游离组织移植一直是广泛颅底重建的金标准，但游离皮瓣覆盖颅底缺损有发生脑脊液（CSF）漏的风险。本研究的目的是评估一种新型技术，即采用部分颅内折叠游离筋膜皮瓣的亚-覆盖联合概念，以评估皮瓣的适用性、多功能性和并发症发生率。在 5 年内，7 例患者接受了游离延伸臂（n=3）或前外侧大腿（n=4）皮瓣游离修复前（n=4）、中（n=2）或后（n=1）颅底缺损。皮瓣部分颅内定位并用骨-真皮缝线固定。两种皮瓣在密封效率、最小化颅内皮瓣体积和折叠方面均具有适用性。未观察到皮瓣丢失。特定并发症包括 1 例因额窦副窦引起的气颅和 1 例因腰椎 CSF 丢失引起的小脑疝。未发生颅内皮瓣部分的皮瓣失败或血肿。使用骨-真皮缝线的筋膜皮瓣这种新型的颅内定位三明治技术概念，应被视为颅底重建的主要治疗方法，而不仅仅是一种挽救措施。
