Shimizu Fumiaki, Oatari Miwako, Matsuda Kaho, Uehara Miyuki, Sato Seiichi, Kato Aiko
From the Department of Plastic Surgery, Faculty of Medicine, Oita University, Oita, Japan.
J Craniofac Surg. 2013 Sep;24(5):1631-5. doi: 10.1097/SCS.0b013e3182999a33.
In case of composite cranial defect including the dura mater, the cranial bone, and the scalp, the fascial component of the anterolateral thigh flap can be used for dural reconstruction. However, the advantages and applications of the fascial component depending on the type of defect have not been thoroughly discussed. We made the algorithm for reconstruction of composite cranial defects using the fascial component of free anterolateral thigh flaps.
Six cases of composite cranial defects were reconstructed using free anterolateral thigh flaps with the fascial component. The type of method used was classified into 3 types. Type 1 involves separating the fascia from the flap completely and using it as a nonvascularized component. In type 2, the fascia is not separated from the flap and is instead used as a vascularized component. Type 3 involves separating the vascularized adipofascial component from the skin paddle and using it as a chimeric pattern flap. The algorithm for determining the type of fascial component is applied depending on the condition of the defect.
All flaps were transferred successfully in every case. In 4 cases, the type 1 method was used. The type 2 and 3 methods were used in 1 case each. Cranial bone reconstruction was performed in 3 cases. There were no major complications after the procedures.
The fascial component is useful for dural reconstruction. The type of fascial component used is selected depending on the condition of the defect.
对于包括硬脑膜、颅骨和头皮的复合性颅骨缺损，股前外侧皮瓣的筋膜成分可用于硬脑膜重建。然而，根据缺损类型，筋膜成分的优势和应用尚未得到充分讨论。我们制定了使用游离股前外侧皮瓣的筋膜成分重建复合性颅骨缺损的算法。
6例复合性颅骨缺损患者采用带筋膜成分的游离股前外侧皮瓣进行重建。所采用的方法类型分为3种。1型是将筋膜与皮瓣完全分离，作为非血管化成分使用。2型是筋膜不与皮瓣分离，而是作为血管化成分使用。3型是将血管化的脂肪筋膜成分与皮瓣分离，作为嵌合型皮瓣使用。根据缺损情况应用确定筋膜成分类型的算法。
所有皮瓣均成功转移。4例采用1型方法。2型和3型方法各使用1例。3例进行了颅骨重建。术后无重大并发症。
筋膜成分对硬脑膜重建有用。根据缺损情况选择所使用的筋膜成分类型。
