Porto Edoardo, Vuncannon Jackson, Revuelta-Barbero J Manuel, Rodas Alejandra, Maldonado Justin, Garzon-Muvdi Tomas, Barrow Emily, Pradilla Gustavo, Solares C Arturo
Department of Neurosurgery, Emory University, Atlanta, Georgia USA.
Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia USA.
World Neurosurg. 2023 May;173:108-113. doi: 10.1016/j.wneu.2023.02.103. Epub 2023 Mar 1.
The radial forearm free flap (RFFF) is an indispensable tool for the reconstruction of a range of defects, including those of the skull base. Several options for routing of the RFFF pedicle have been described, and the parapharyngeal corridor (PC) has been proposed as an option and employed for a nasopharyngeal defect. However, there are no reports of its use for the reconstruction of anterior skull base defects. The objective of this study is to describe the technique for free tissue reconstruction of anterior skull base defects using the RFFF and routing of the pedicle via the PC.
Relevant neurovascular landmarks and critical surgical steps for reconstruction of anterior skull base defects with an RFFF and routing of the pedicle via the PC are reported using an illustrative clinical case and cadaveric dissections.
We present a case of a 70-year-old man who underwent endoscopic transcribriform resection of cT4N0 sinonasal squamous cell carcinoma and was left with a large anterior skull base defect that persisted despite several repair attempts. An RFFF was utilized to repair the defect. This report is the first description of the clinical use of the PC for free tissue repair of an anterior skull base defect.
The PC is an option for routing the pedicle during the reconstruction of anterior skull base defects. When the corridor is prepared as described in this case, a direct route exists from the anterior skull base to cervical vessels, simultaneously maximizing the reach of the pedicle and minimizing the risk of kinking.
桡侧前臂游离皮瓣（RFFF）是修复包括颅底缺损在内的一系列缺损的重要工具。已经描述了几种RFFF蒂部的走行方式，并且咽旁通道（PC）已被提出作为一种选择并用于修复鼻咽部缺损。然而，尚无其用于修复前颅底缺损的报道。本研究的目的是描述使用RFFF修复前颅底缺损并通过PC走行蒂部的游离组织重建技术。
通过一个具有说明性的临床病例和尸体解剖，报告使用RFFF修复前颅底缺损并通过PC走行蒂部的相关神经血管标志和关键手术步骤。
我们报告了一例70岁男性患者，其接受了cT4N0鼻窦鳞状细胞癌的内镜经筛窦切除术，尽管多次尝试修复，但仍遗留一个大的前颅底缺损。使用RFFF修复该缺损。本报告首次描述了PC在前颅底缺损游离组织修复中的临床应用。
PC是前颅底缺损重建中蒂部走行的一种选择。按照本病例所述准备通道时，从前颅底到颈部血管存在一条直接路径，同时可使蒂部的长度最大化并使扭结风险最小化。
