Siu Alan, Rangarajan Sanjeet V, Rabinowitz Mindy R, Luginbuhl Adam, Rimmer Ryan A, Chitguppi Chandala, Farrell Christopher, Nyquist Gurston G, Rosen Marc R, Evans James J
Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN.
Int Forum Allergy Rhinol. 2020 Nov;10(11):1249-1254. doi: 10.1002/alr.22609. Epub 2020 Jul 7.
The ability to reconstruct large cranial base defects has greatly improved with the development of pedicled vascularized flaps. The temporoparietal fascia flap (TPFF) is a viable alternative to the Hadad-Bassagasteguy nasoseptal flap for large ventral skull-base defects. This study aims to characterize the size of the TPFF necessary for optimal ventral skull-base reconstruction.
Eleven formaldehyde-fixed cadaveric heads were used to harvest TPFF of varying heights on each side (total = 22). TPFF was passed through the pterygomaxillary fissure (PMF) to the ventral skull base to assess its coverage. For a subgroup of 12 sides, the TPFF was trimmed to determine the minimum height necessary for coverage.
The TPFF height was (mean ± standard deviation [SD]) 14.72 ± 1.02 cm (range, 12.5 to 16.5 cm) and width was 8.43 ± 1.05 cm (range, 6 to 10.5 cm). The distance from the TPFF pedicle through the PMF was 5.8 ± 0.5 cm (range, 5 to 6.5 cm). All TPFF flaps provided complete ipsilateral coverage of clival defects, and all but 1 covered the entire clivus. All TPFF flaps, when rotated anteriorly, provided coverage up to the cribriform plate. The minimum TPFF height necessary for complete coverage of cribriform defects and ventral defects up to the planum sphenoidale was 12 cm. TPFF height for specimens with and without complete ventral skull-base coverage was significantly different (p < 0.0001).
The TPFF is a versatile alternative to the nasoseptal flap and a height of at least 12 cm can provide enough coverage for all ventral skull base defects.
随着带蒂血管化皮瓣的发展，大型颅底缺损的重建能力有了很大提高。颞顶筋膜瓣（TPFF）是用于大型腹侧颅底缺损的哈达德 - 巴萨加斯特盖鼻中隔瓣的可行替代方案。本研究旨在确定最佳腹侧颅底重建所需的TPFF尺寸。
使用11个甲醛固定的尸体头部，在每侧获取不同高度的TPFF（共22个）。将TPFF通过翼上颌裂（PMF）转移至腹侧颅底以评估其覆盖范围。对于12侧的亚组，修剪TPFF以确定覆盖所需的最小高度。
TPFF高度为（平均值±标准差[SD]）14.72±1.02厘米（范围12.5至16.5厘米），宽度为8.43±1.05厘米（范围6至10.5厘米）。从TPFF蒂部穿过PMF的距离为5.8±0.5厘米（范围5至6.5厘米）。所有TPFF皮瓣均能完全同侧覆盖斜坡缺损，除1个外均覆盖整个斜坡。所有TPFF皮瓣向前旋转时，可覆盖至筛板。完全覆盖筛板缺损和直至蝶骨平台的腹侧缺损所需的最小TPFF高度为12厘米。有和没有完全腹侧颅底覆盖的标本的TPFF高度有显著差异（p < 0.0001）。
TPFF是鼻中隔瓣的一种通用替代方案，至少12厘米的高度可为所有腹侧颅底缺损提供足够的覆盖。
