Patel Neil S, Modest Mara C, Brobst Tyler D, Carlson Matthew L, Price Daniel L, Moore Eric J, Janus Jeffrey R
Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A.
Laryngoscope. 2016 Aug;126(8):1911-7. doi: 10.1002/lary.25717. Epub 2015 Oct 15.
OBJECTIVES/HYPOTHESIS: We sought to analyze key factors that influence the management of lateral skull base defects and implement an algorithm to improve outcomes of reconstruction.
Retrospective chart review.
Single tertiary academic referral center.
Adults who underwent temporal bone resection were included. Variables included tumor characteristics, ablative procedure, reconstructive method, and wound complications.
Seventy-one patients were studied. Lateral temporal bone resection was performed in 55 patients (77%), subtotal temporal bone resection in 14 (20%), and total petrosectomy in two (3%). Primary closure was achieved in 46 patients (35%), with rotational muscle flaps in 21 (46%). The pectoralis major myocutaneous flap (PMMF) was used in nine patients (13%) without major complications. Single-stage free tissue transfer was undertaken in 10 patients (14%) with no flap failures. Primary closure was achieved in 16 of 32 of previously untreated cases (50%) compared to nine of 39 cases of previously treated disease (23%) (P = 0.03). Pedicled or free flaps were used in 18 of 39 cases of previously treated disease (46%) compared to three of 32 previously untreated cases (9%) (P < 0.001). Pedicled or free flaps were used in 13 of 22 cases (59%) in which partial or total auriculectomy was performed, whereas primary closure was achieved in 39 of 49 cases (80%) in which the pinna was preserved (P < 0.001).
Advanced tumors that require adjuvant therapy, revision cases for recurrent disease, and cases involving auriculectomy warrant free flap or PMMF reconstruction, with the latter preferred in poor free flap candidates.
目的/假设：我们试图分析影响侧颅底缺损处理的关键因素，并实施一种算法以改善重建效果。
回顾性病历审查。
单一的三级学术转诊中心。
纳入接受颞骨切除术的成年人。变量包括肿瘤特征、切除手术、重建方法和伤口并发症。
共研究了71例患者。55例患者（77%）进行了外侧颞骨切除术，14例（20%）进行了颞骨次全切除术，2例（3%）进行了全岩骨切除术。46例患者（35%）实现了一期缝合，21例（46%）采用了旋转肌皮瓣。9例患者（13%）使用了胸大肌肌皮瓣（PMMF），无严重并发症。10例患者（14%）进行了单阶段游离组织移植，无皮瓣失败。32例未经治疗的病例中有16例（50%）实现了一期缝合，而39例既往治疗过的疾病病例中有9例（23%）实现了一期缝合（P = 0.03）。39例既往治疗过的疾病病例中有18例（46%）使用了带蒂或游离皮瓣，而32例未经治疗的病例中有3例（9%）使用了带蒂或游离皮瓣（P < 0.001）。22例进行部分或全耳廓切除术的病例中有13例（59%）使用了带蒂或游离皮瓣，而49例保留耳廓的病例中有39例（80%）实现了一期缝合（P < 0.001）。
需要辅助治疗的晚期肿瘤、复发性疾病的翻修病例以及涉及耳廓切除术的病例，应采用游离皮瓣或PMMF重建，对于游离皮瓣条件较差的患者，优先选择后者。
4。《喉镜》，126:1911 - 1917，2016年。
