Meier Joshua C, Bleier Benjamin S
Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles St., Boston MA 02114, USA.
Adv Otorhinolaryngol. 2013;74:64-70. doi: 10.1159/000342281. Epub 2012 Dec 18.
The expansion of endoscopic skull base surgery has resulted in the creation of large defects that must be repaired to ensure separation of the cranial vault from the nasal cavity. The workhorse of anterior skull base reconstruction remains the nasoseptal or Hadad-Bassagasteguy flap. Despite its success, the nasoseptal flap is limited in its ability to reach extremely anterior defects including those involving the frontal break, posterior frontal table, and anterior cribiform plate. Alternative approaches utilizing anteriorly pedicled flaps have been described which exploit the vascular supply to the anterior septum and lateral nasal wall. The diminutive nature of the anterior septal blood supply has led to the elaboration of a bipedicled anterior septal flap which is capable of reliable reconstruction of both the frontal beak as well as posterior frontal table defects. Similarly anteriorly based inferior turbinate flaps pedicled largely on anterior ethmoid arborizations have been used successfully to reconstruct anterior defects. In light of the limitations of the nasoseptal flap, the addition of anteriorly pedicled flaps to the clinical armamentarium offers the opportunity to provide vascularized mucosal coverage of virtually any region of the skull base which can be reached endoscopically.
内镜颅底手术的扩展导致了大的缺损的产生，必须对这些缺损进行修复以确保颅顶与鼻腔分离。鼻中隔或哈达德 - 巴萨加斯特盖皮瓣仍然是前颅底重建的主要手段。尽管取得了成功，但鼻中隔皮瓣在到达极前位缺损（包括涉及额突、额骨后板和前筛板的缺损）方面的能力有限。已经描述了利用带蒂前位皮瓣的替代方法，这些方法利用了鼻中隔前部和鼻侧壁的血供。鼻中隔前部血供的微小性质促使人们设计了一种双蒂鼻中隔皮瓣，它能够可靠地修复额突以及额骨后板缺损。同样，主要以前筛动脉分支为蒂的带蒂前位下鼻甲皮瓣已成功用于修复前部缺损。鉴于鼻中隔皮瓣的局限性，将带蒂前位皮瓣添加到临床手段中为在内镜下能够到达的几乎任何颅底区域提供血管化黏膜覆盖提供了机会。
