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多层阔筋膜用于颅底重建:单中心17年经验

Skull Base Reconstruction with Multilayered Fascia Lata: A Single-Center 17 Years Experience.

作者信息

Ringel Barak, Abergel Avraham, Horowitz Gilad, Safadi Ahmad, Zaretski Arik, Yanko Ravit, Margalit Nevo, Fliss Dan M

机构信息

Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Department of Plastics and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

出版信息

J Neurol Surg B Skull Base. 2021 Jul;82(Suppl 3):e217-e223. doi: 10.1055/s-0039-3402013. Epub 2020 Jan 8.

Abstract

Reconstruction after open surgery of anterior skull base lesions is challenging. The fascia lata graft is our workhorse for achieving dural sealing and preventing cerebrospinal fluid leak and meningitis. This study seeks to analyze the donor and recipient site complication rates after fascia lata reconstruction.  This is a retrospective review of all open anterior skull base operations in which a double-layer fascia lata graft was used for the reconstruction of the defect from 2000 to 2016 at the Tel-Aviv Sourasky Medical Center, a tertiary referral center in Israel.  Of the 369 patients operated for skull base lesions, 119 underwent open anterior skull base surgery and were reconstructed with a fascia lata graft. The patients' mean age was 47.1 years, and 68 (57.1%) were males. The overall postoperative early and late donor site complication rates were 6.7% (  = 8) and 5.9% (  = 7), respectively. Multivariate analysis found minor comorbidities and persistent/recurrent disease as being predictors for early-term complications. The overall postoperative early central nervous system (CNS) complication rate was 21.8% (  = 26), while 12.6% (  = 15) of the patients had late postoperative CNS complications.  Reconstruction of open anterior skull base lesions with fascia lata grafting is a safe procedure with acceptable complication and donor site morbidity rates.

摘要

前颅底病变开放手术后的重建具有挑战性。阔筋膜移植是我们实现硬脑膜封闭、预防脑脊液漏和脑膜炎的主要手段。本研究旨在分析阔筋膜重建术后供体和受体部位的并发症发生率。

这是一项对2000年至2016年在以色列三级转诊中心特拉维夫索拉斯基医疗中心进行的所有前颅底开放手术的回顾性研究,这些手术中使用双层阔筋膜移植来重建缺损。

在369例接受颅底病变手术的患者中,119例接受了前颅底开放手术并用阔筋膜移植进行重建。患者的平均年龄为47.1岁,68例(57.1%)为男性。术后供体部位早期和晚期并发症的总体发生率分别为6.7%(n = 8)和5.9%(n = 7)。多因素分析发现轻度合并症和疾病持续/复发是早期并发症的预测因素。术后早期中枢神经系统(CNS)并发症的总体发生率为21.8%(n = 26),而12.6%(n = 15)的患者有术后晚期CNS并发症。

用阔筋膜移植重建前颅底开放病变是一种安全的手术,并发症和供体部位发病率可接受。

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Skull Base Reconstruction with Multilayered Fascia Lata: A Single-Center 17 Years Experience.多层阔筋膜用于颅底重建:单中心17年经验
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本文引用的文献

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Open Anterior Skull Base Reconstruction: A Contemporary Review.开放性前颅底重建:当代综述
Semin Plast Surg. 2017 Nov;31(4):189-196. doi: 10.1055/s-0037-1607273. Epub 2017 Oct 25.
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Otolaryngol Clin North Am. 2016 Feb;49(1):107-17. doi: 10.1016/j.otc.2015.09.006.
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Minimally invasive fascia lata harvest: a new method.微创阔筋膜取材:一种新方法。
Plast Reconstr Surg Glob Open. 2013 May 7;1(1). doi: 10.1097/GOX.0b013e31828c4406. eCollection 2013 Apr.
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Free tensor fascia lata flap and synthetic mesh reconstruction for full-thickness chest wall defect.
Case Rep Med. 2013;2013:914716. doi: 10.1155/2013/914716. Epub 2013 Sep 28.
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Management of posttraumatic radioulnar synostosis.创伤后尺桡骨骨化性肌炎的治疗。
J Am Acad Orthop Surg. 2012 Jul;20(7):450-8. doi: 10.5435/JAAOS-20-07-450.

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