Howard Brittany E, Nagel Thomas H, Barrs David M, Donald Carrlene B, Hayden Richard E
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA.
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
Otolaryngol Head Neck Surg. 2016 Jun;154(6):1014-8. doi: 10.1177/0194599816634296. Epub 2016 Mar 15.
To compare reconstructive techniques, operative times, duration of hospitalization, and need for subsequent flap revisions between reconstructive approaches to lateral skull base defects.
Case series with chart review.
Tertiary academic referral center.
Patients (n = 31) undergoing reconstruction of composite lateral skull base defects from 2002 to 2014.
Data were analyzed for demographics, tumor characteristics, reconstructive technique, operative time, duration of hospitalization, complications, and outcomes.
Thirty-one patients were identified for inclusion. Lateral temporal bone defects resulted from resection of malignant lesions, including squamous cell carcinoma (n = 25), basal cell carcinoma (n = 2), and other carcinoma (n = 4). Defects were reconstructed with submental flaps (n = 16), pedicled latissimus dorsi flaps (n = 6), and free anterolateral thigh flaps (n = 9). All cases involved neurosurgery, neurotology, and head and neck surgery services. Although time of surgical resection was similar, time saving was noticed with submental reconstruction. Compared with free flaps, submental flap reconstruction was associated with significantly reduced total operative time (mean, 544 vs 683 min; P = .00817) and duration of hospitalization (4.9 vs 9.8 days; P = .02067). Submental flaps were significantly less likely to require revision debulking procedures (mean = 0.6) compared with latissimus dorsi flaps (mean, 1.3; P < .00001) and free flaps (mean, 1.6; P < .00001). There was 100% flap survival.
The musculocutaneous submental flap provides an excellent option for reconstruction of lateral skull base defects given its proximity, reliability, ease of harvest, and exceptional color match. Submental flap reconstruction was associated with reduced operative time, hospitalization duration, and flap revisions.
比较外侧颅底缺损的重建方法在重建技术、手术时间、住院时间以及后续皮瓣修复需求方面的差异。
病例系列研究并进行病历回顾。
三级学术转诊中心。
2002年至2014年间接受外侧颅底复合缺损重建手术的31例患者。
分析患者的人口统计学资料、肿瘤特征、重建技术、手术时间、住院时间、并发症及治疗结果。
共纳入31例患者。外侧颞骨缺损由恶性病变切除所致，包括鳞状细胞癌（25例）、基底细胞癌（2例）和其他癌症（4例）。缺损采用颏下皮瓣（16例）、带蒂背阔肌皮瓣（6例）和游离股前外侧皮瓣（9例）进行重建。所有病例均涉及神经外科、耳神经外科及头颈外科。尽管手术切除时间相似，但颏下重建节省时间。与游离皮瓣相比，颏下皮瓣重建的总手术时间显著缩短（平均544分钟对683分钟；P = 0.00817），住院时间也显著缩短（4.9天对9.8天；P = 0.02067）。与背阔肌皮瓣（平均1.3次；P < 0.00001）和游离皮瓣（平均1.6次；P < 0.00001）相比，颏下皮瓣需要进行修复减容手术的可能性显著降低（平均0.6次）。皮瓣存活率为100%。
肌皮颏下皮瓣因其位置接近、可靠性高、易于切取且颜色匹配良好，为外侧颅底缺损的重建提供了极佳选择。颏下皮瓣重建与手术时间缩短、住院时间缩短及皮瓣修复次数减少相关。
