Kwon Seung Gee, Kim Yong Oock, Rah Dong Kyun
Institute of Human Tissue Restoration, Department of Plastic and Reconstructive Surgery, Yonsei University Health System, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Arch Plast Surg. 2012 Jul;39(4):345-51. doi: 10.5999/aps.2012.39.4.345. Epub 2012 Jul 13.
Cranial base defects are challenging to reconstruct without serious complications. Although free tissue transfer has been used widely and efficiently, it still has the limitation of requiring a long operation time along with the burden of microanastomosis and donor site morbidity. We propose using a reverse temporalis muscle flap and calvarial bone graft as an alternative option to a free flap for anterior cranial base reconstruction.
Between April 2009 and February 2012, cranial base reconstructions using an autologous calvarial split bone graft combined with a reverse temporalis muscle flap were performed in five patients. Medical records were retrospectively analyzed and postoperative computed tomography scans, magnetic resonance imaging, and angiography findings were examined to evaluate graft survival and flap viability.
The mean follow-up period was 11.8 months and the mean operation time for reconstruction was 8.4±3.36 hours. The defects involved the anterior cranial base, including the orbital roof and the frontal and ethmoidal sinus. All reconstructions were successful. Viable flap vascularity and bone survival were observed. There were no serious complications except for acceptable donor site depressions, which were easily corrected with minor procedures.
The reverse temporalis muscle flap could provide sufficient bulkiness to fill dead space and sufficient vascularity to endure infection. The calvarial bone graft provides a rigid framework, which is critical for maintaining the cranial base structure. Combined anterior cranial base reconstruction with a reverse temporalis muscle flap and calvarial bone graft could be a viable alternative to free tissue transfer.
颅底缺损的重建具有挑战性，且容易出现严重并发症。尽管游离组织移植已被广泛且有效地应用，但它仍存在手术时间长、显微吻合负担重以及供区并发症等局限性。我们提出使用颞肌反转皮瓣和颅骨骨移植作为游离皮瓣的替代方案，用于前颅底重建。
2009年4月至2012年2月期间，对5例患者采用自体颅骨劈开骨移植联合颞肌反转皮瓣进行颅底重建。对病历进行回顾性分析，并检查术后计算机断层扫描、磁共振成像和血管造影结果，以评估移植骨的存活情况和皮瓣的活力。
平均随访期为11.8个月，重建手术的平均时间为8.4±3.36小时。缺损累及前颅底，包括眶顶、额窦和筛窦。所有重建均成功。观察到皮瓣血管存活和骨存活。除了供区出现可接受的凹陷外，无严重并发症，这些凹陷可通过小手术轻松矫正。
颞肌反转皮瓣可提供足够的体积以填充死腔，并提供足够的血管以耐受感染。颅骨骨移植提供了一个坚固的框架，这对于维持颅底结构至关重要。联合使用颞肌反转皮瓣和颅骨骨移植进行前颅底重建可能是游离组织移植的一个可行替代方案。
