Thompson Nicholas J, Roche Joseph P, Schularick Nathan M, Chang Kristi E, Hansen Marlan R
*Department of Otolaryngology-Head and Neck Surgery, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa †Current addresses: Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina ‡Department of Surgery/Division of Otolaryngology, School of Medicine and Public Health, The University of Wisconsin-Madison, Madison, Wisconsin.
Otol Neurotol. 2017 Feb;38(2):264-271. doi: 10.1097/MAO.0000000000001279.
Compare reconstruction outcomes for various lateral skull base closure techniques.
Retrospective medical records review.
University-based tertiary referral center.
Patients who underwent resections of tumors involving the lateral skull base requiring reconstruction beyond primary closure.
INTERVENTION(S): Reconstructive techniques, from rotational flaps to free tissue transfer.
MAIN OUTCOME MEASURE(S): Outcome data including wound complications, cerebrospinal fluid (CSF) leakage, and need for surgical revision were tabulated.
Eighty-six patients underwent lateral skull base tumor resection and reconstruction. Procedures were primarily lateral temporal bone resections but also included subtotal temporal bone, total temporal bone, and infratemporal fossa resections. Cutaneous malignancy was the most common resection indication (83%) and the temporalis rotational flap was the most commonly employed reconstructive option (30%). When free tissue transfer techniques were used, the radial forearm, anterolateral thigh, and latissimus dorsi were the most frequent donor sites. Patients with T2 disease were more likely to undergo temporalis flaps, whereas patients with T4 disease were more likely to undergo free flap reconstruction. Major complications were uncommon (∼8%), the most frequent being stroke (∼3%). The postoperative wound complication rate was approximately 45%. The majority involved minor dehiscences and were managed conservatively. Patients with T4 disease were more likely to have wound complications (p < 0.05). Radial forearm free flaps were less likely to have wound complications when compared with other reconstruction techniques (p < 0.05).
Many factors go into planning lateral skull base reconstruction. Free flaps were more often used for T4 disease. Radial forearm free flaps tended to have lower wound complication rates when compared with other techniques.
比较各种侧颅底闭合技术的重建效果。
回顾性病历审查。
大学附属三级转诊中心。
接受侧颅底肿瘤切除术且需要在一期缝合之外进行重建的患者。
从旋转皮瓣到游离组织移植的重建技术。
将包括伤口并发症、脑脊液漏及手术翻修需求在内的结果数据制成表格。
86例患者接受了侧颅底肿瘤切除及重建手术。手术主要为颞骨外侧切除术，但也包括颞骨次全切除术、颞骨全切除术及颞下窝切除术。皮肤恶性肿瘤是最常见的切除指征（83%），颞肌旋转皮瓣是最常用的重建方式（30%）。使用游离组织移植技术时，最常用的供区是桡侧前臂、股前外侧及背阔肌。T2期疾病患者更可能接受颞肌皮瓣手术，而T4期疾病患者更可能接受游离皮瓣重建。主要并发症不常见（约8%），最常见的是中风（约3%）。术后伤口并发症发生率约为45%。大多数为轻微裂开，采用保守治疗。T4期疾病患者更易出现伤口并发症（p<0.05）。与其他重建技术相比，桡侧前臂游离皮瓣出现伤口并发症的可能性较小（p<0.05）。
侧颅底重建的规划涉及诸多因素。T4期疾病更多使用游离皮瓣。与其他技术相比，桡侧前臂游离皮瓣的伤口并发症发生率往往较低。
