Vitali Matteo, Canevari Frank Rikki, Cattalani Andrea, Grasso Vincenzo, Somma Teresa, Barbanera Andrea
Surgical Department, Neurosurgical Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Via Venezia 16, 15121 Alessandria, Italy.
Department of Otorhinolaryngology, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Via Venezia 16, 15121 Alessandria, Italy.
Clin Neurol Neurosurg. 2016 May;144:59-63. doi: 10.1016/j.clineuro.2016.03.003. Epub 2016 Mar 7.
Fascia lata is a validated source of autologous grafts, adopted by many surgical figures throughout different types of reconstructive procedures. Postoperative pain and muscle prolapse are frequent complications after harvesting fascia lata; donor site morbidity causes delayed mobilization and increased lenght of hospital stay. In our department fascia lata is used as autologous graft in reconstruction of skull base after extended endoscopic transsphenoidal surgery (EETS) and the thigh defect is usually repaired with allograft to restore tissue continuity and avoid muscle prolapse. Our aim was to evaluate the post-operative pain and muscle prolapse in a group of patients who underwent EETS with fascia lata reconstruction with allograft.
We retrospectively analyzed clinical data of 11 patients who underwent harvesting and reconstruction of fascia lata during EETS, collected in our department of Neurosurgery between January 2012 and September 2015. "Pain on rest" and "pain on walking" data were collected daily according to the Numerical Rating Scale (NRS) system, during hospital stay until sutures removal and 1 month after surgery. Furthermore, the degree of muscle prolapse was analyzed at the time of sutures removal and 1 month following surgery.
11 patients were studied between January 2012 and September 2015: 4 men and 7 women (1:1.75). Mean age 53.6±11.1years. During the post-operative stay, "pain on rest" and "pain on walking" values of all patients did not exceed grade 4 of NRS. While removing sutures, "pain on rest" resulted grade 1 of NRS in 27.3% (3/11) patients, while "pain on walking" was grade 1 of NRS in 18.2% (2/11) and grade 2 in 9.1% (1/11). After a month of surgery "pain on rest" reduced to NRS grade 1 in 9.1% (1/11), while patients NRS results for "pain on walking" were the same as the previous evaluation. Mean duration of hospital stay was 5.7±2.28 days. 10 patients were discharged home, only 1 patient was transferred to a rehabilitation ward. No visible nor palpable muscle prolapse was found in our group of patients during the entire assessment.
Findings show how fascia lata reconstruction with allograft reduced post-operative discomfort and muscle prolapse in our serie; it also permitted their early mobilization and discharge. These are promising results. However further studies are needed to see this technique approved.
阔筋膜是一种经过验证的自体移植物来源，被许多外科医生应用于不同类型的重建手术中。阔筋膜取材术后，疼痛和肌肉脱垂是常见的并发症；供区并发症会导致活动延迟和住院时间延长。在我们科室，阔筋膜被用作扩大经蝶窦内镜手术（EETS）后颅底重建的自体移植物，大腿缺损通常用同种异体移植物修复，以恢复组织连续性并避免肌肉脱垂。我们的目的是评估一组接受EETS并采用同种异体移植物进行阔筋膜重建的患者的术后疼痛和肌肉脱垂情况。
我们回顾性分析了2012年1月至2015年9月期间在我们神经外科收集的11例接受EETS期间进行阔筋膜取材和重建的患者的临床资料。根据数字评分量表（NRS）系统，在住院期间直至拆线以及术后1个月，每天收集“静息痛”和“行走痛”数据。此外，在拆线时和术后1个月分析肌肉脱垂程度。
2012年1月至2015年9月期间研究了11例患者：4例男性和7例女性（1:1.75）。平均年龄53.6±11.1岁。在术后住院期间，所有患者的“静息痛”和“行走痛”值均未超过NRS 4级。拆线时，27.3%（3/11）的患者“静息痛”为NRS 1级，而“行走痛”为NRS 1级的患者占18.2%（2/11），为NRS 2级的患者占9.1%（1/11）。术后1个月，“静息痛”降至NRS 1级的患者占9.1%（1/11），而患者“行走痛”的NRS结果与之前的评估相同。平均住院时间为5.7±2.28天。10例患者出院回家，只有1例患者被转至康复病房。在整个评估过程中，我们的患者组中未发现明显或可触及的肌肉脱垂。
研究结果表明，同种异体移植物阔筋膜重建在我们的系列研究中减少了术后不适和肌肉脱垂；它还使患者能够早期活动和出院。这些结果很有前景。然而，需要进一步研究以使该技术得到认可。
