Choi Woo Young, Sung Ki Wook, Kim Young Seok, Hong Jong Won, Roh Tai Suk, Lew Dae Hyun, Chang Jong Hee, Lee Kyu Sung
From the *Department of Plastic and Reconstructive Surgery, Chosun University College of Medicine, Gwangju; †Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, and ‡Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.
Ann Plast Surg. 2017 Jun;78(6):673-679. doi: 10.1097/SAP.0000000000000909.
Skull base reconstruction is a challenging task. The method depends on the anatomical complexity and size of the defect. We obtained tissue by harvesting fat-containing perifascial areolar tissue (PAT) for reconstruction of limited skull base defects and volume augmentation. We demonstrated the effective option for reconstruction of limited skull base defects and volume augmentation. From October 2013 to November 2015, 5 patients underwent operations using fat-containing PAT to fill the defect in skull base and/or perform volume replacement in the forehead. Perifascial areolar tissue with 5- to 10-mm fat thickness was harvested from the inguinal region. The fat-containing PAT was grafted to the defect contacting the vascularized wound bed. Patients were followed up in terms of their clinical symptoms and postoperative magnetic resonance imaging findings. Four patients were treated using fat-containing PAT after tumor resection. One patient was treated for a posttraumatic forehead depression deformity. The fat-containing PAT included 5- to 9-mm fat thickness in all cases. The mean size of grafted PAT was 65.6 cm (28-140 cm). The mean follow-up period was 18.6 months (12-31 months). There was no notable complication. There was no donor site morbidity. We can harvest PAT with fat easily and obtain the sufficient volume to treat the defect. It also could be used with other reconstructive method, such as a free flap or a regional flap to fill the left dead space. Therefore, fat-containing PAT could be additional options to reconstruction of skull base defect.
颅底重建是一项具有挑战性的任务。该方法取决于缺损的解剖复杂性和大小。我们通过采集含脂肪的筋膜周蜂窝组织（PAT）来获取组织，用于有限颅底缺损的重建和容积增加。我们证明了这是一种用于有限颅底缺损重建和容积增加的有效方法。2013年10月至2015年11月，5例患者接受了使用含脂肪PAT的手术，以填充颅底缺损和/或在前额进行容积替代。从腹股沟区采集脂肪厚度为5至10毫米的筋膜周蜂窝组织。将含脂肪的PAT移植到与血管化伤口床接触的缺损处。根据患者的临床症状和术后磁共振成像结果进行随访。4例患者在肿瘤切除后使用含脂肪PAT进行治疗。1例患者因创伤后前额凹陷畸形接受治疗。所有病例中，含脂肪的PAT脂肪厚度为5至9毫米。移植的PAT平均大小为65.6平方厘米（28 - 140平方厘米）。平均随访期为18.6个月（12 - 31个月）。未出现明显并发症。供区无并发症。我们可以轻松采集含脂肪的PAT，并获得足够的容积来治疗缺损。它还可与其他重建方法联合使用，如游离皮瓣或局部皮瓣，以填充剩余的死腔。因此，含脂肪的PAT可作为颅底缺损重建的额外选择。
