内镜时代的挽救性颅底重建：游离股外侧肌组织瓣转移术
Salvage skull base reconstruction in the endoscopic era: Vastus lateralis free tissue transfer.
作者信息
Kang Stephen Y, Eskander Antoine, Hachem Ralph Abi, Ozer Enver, Teknos Theodoros N, Old Matthew O, Prevedello Daniel M, Carrau Ricardo L
机构信息
Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio.
Department of Neurosurgery, The Ohio State Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio.
出版信息
Head Neck. 2018 Apr;40(4):E45-E52. doi: 10.1002/hed.25094. Epub 2018 Feb 6.
BACKGROUND
When locoregional flaps fail to reconstruct the skull base, the microvascular surgeon faces several reconstructive challenges. We present our technique and results of salvage anterior skull base reconstruction utilizing the vastus lateralis free tissue transfer (VLFTT).
METHODS
Four patients with anterior skull base defects after previous locoregional flap failure underwent free tissue transfer reconstruction with VLFTT.
RESULTS
The success rate of free tissue transfer was 100%. Complete separation of the intracranial and sinonasal cavities was achieved in all patients; thus, resolving the cerebrospinal fluid (CSF) leakage in all patients. The VLFTT was inset through a minimally invasive approach utilizing an anterior maxillotomy via a gingivobuccal incision, an endoscopic medial maxillectomy, and endoscopic inset in all patients. No vein grafts were needed.
CONCLUSION
This technique permits endoscopic endonasal inset and placement of reliable, well vascularized free tissue that may be utilized for complex, secondary reconstruction of the skull base.
背景
当局部区域皮瓣无法用于重建颅底时，微血管外科医生面临着多项重建挑战。我们展示了利用股外侧肌游离组织瓣转移（VLFTT）进行挽救性前颅底重建的技术及结果。
方法
4例先前局部区域皮瓣失败后出现前颅底缺损的患者接受了VLFTT游离组织瓣转移重建术。
结果
游离组织瓣转移成功率为100%。所有患者均实现了颅内和鼻窦腔的完全分隔，从而解决了所有患者的脑脊液（CSF）漏问题。所有患者均通过经牙龈颊侧切口的上颌骨前部切开术、内镜下内侧上颌骨切除术及内镜下植入，采用微创方法植入VLFTT。无需静脉移植。
结论
该技术允许通过鼻内镜经鼻内植入并放置可靠的、血供良好的游离组织，可用于颅底复杂的二期重建。
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