Herr Marc W, Lin Derrick T
Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
Adv Otorhinolaryngol. 2013;74:81-91. doi: 10.1159/000342283. Epub 2012 Dec 18.
The anatomical challenges of skull base surgery are well known. Furthermore, ablative and traumatic defects in this region produce complex reconstructive problems with a high risk of significant postoperative morbidity and mortality. Over the past two decades, microvascular free tissue reconstruction following open resection has been shown to improve outcomes and reduce complication rates when compared to the traditional use of pedicled flaps. The increasing use of free tissue transfer has been further strengthened by improved technical expertise and high flap success rates. Since the size and type of free tissue to be utilized must be individualized to each defect, the accomplished reconstructive surgeon should be extremely versatile and, by extension, facile with a several types of free flaps. Thus, four of the most commonly used flaps--the rectus abdominis, radial forearm, latissimus dorsi and anterolateral thigh flaps--are discussed.
颅底手术的解剖学挑战是众所周知的。此外，该区域的切除性和创伤性缺损会产生复杂的重建问题，术后出现严重发病和死亡的风险很高。在过去二十年中，与传统使用带蒂皮瓣相比，开放切除术后的微血管游离组织重建已被证明可改善治疗效果并降低并发症发生率。技术专长的提高和皮瓣成功率的提升进一步推动了游离组织移植的更多应用。由于所使用的游离组织的大小和类型必须针对每个缺损进行个体化选择，技艺娴熟的重建外科医生应具备极其全面的技能，进而能够熟练运用多种类型的游离皮瓣。因此，本文将讨论最常用的四种皮瓣——腹直肌皮瓣、桡侧前臂皮瓣、背阔肌皮瓣和股前外侧皮瓣。
