Okafor Somtochi I, Patel Viraj M, Lazutkin Anna, Jang David W, Goldstein Bradley J, Ramakrishnan Jeevan, Abi Hachem Ralph
Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, USA.
Triangle Sinus Center, Raleigh, NC, USA.
Ann Otol Rhinol Laryngol. 2025 Aug 4:34894251357788. doi: 10.1177/00034894251357788.
To describe a novel flap, the anteriorly based middle turbinate flap (ABMTF), via a cadaveric dissection, as well as present our experience using the ABMTF in 13 patients.
Cadaver dissection study demonstrating methodology of harvesting the ABMTF. Retrospective chart review of 13 patients from a tertiary rhinology referral center undergoing CSF leak repair using the ABMTF from January 2017 to August 2023. Five cadaveric specimens were utilized to complete the dissection of the ABMTF. Flap dimensions and surface area were measured. A step-by-step surgical technique was recorded to illustrate a video demonstration. Demographic data, BMI, pre and postoperative SNOT 22 scores, size and location of the skull base defect, and flap measurements on computed tomography (CT) were obtained from the electronic medical record.
Five ABMTF were dissected and showed a mean flap surface area for the medial ABMTF of 3.45 cm with a range of 2.5 to 4.46 cm and a mean surface area for the lateral ABMTF of 2 cm. The mean surface area of the flap on CT scan measurements was 3.46 cm. Twelve patients were female, with an average BMI of 35.1 kg/m. Ten out of 13 patients were treated post-operatively with acetazolamide for management of presumed intracranial hypertension. Postoperative SNOT 22 scores significantly improved at the last follow up visit. All patients had excellent flap tissue integration at their latest follow up with no postoperative CSF leak.
The ABMTF is a novel random flap, vascularized by branches of the anterior ethmoid artery, that is effective in skull base reconstruction and CSF leak repair emanating from the anterior skull base between the frontal recess and the posterior ethmoid artery along the ethmoid roof. This flap is versatile with limited morbidity.
通过尸体解剖描述一种新型皮瓣——前基底中鼻甲皮瓣（ABMTF），并介绍我们在13例患者中使用ABMTF的经验。
尸体解剖研究展示获取ABMTF的方法。对一家三级鼻科学转诊中心2017年1月至2023年8月期间使用ABMTF进行脑脊液漏修补的13例患者进行回顾性病历审查。使用5个尸体标本完成ABMTF的解剖。测量皮瓣尺寸和表面积。记录详细的手术技术步骤以制作视频演示。从电子病历中获取人口统计学数据、体重指数（BMI）、术前和术后的鼻窦鼻相关生活质量量表（SNOT 22）评分、颅底缺损的大小和位置以及计算机断层扫描（CT）上的皮瓣测量数据。
解剖了5个ABMTF，内侧ABMTF的平均皮瓣表面积为3.45平方厘米，范围为2.5至4.46平方厘米，外侧ABMTF的平均表面积为2平方厘米。CT扫描测量的皮瓣平均表面积为3.46平方厘米。12例患者为女性，平均BMI为35.1kg/m²。13例患者中有10例术后使用乙酰唑胺治疗以处理假定的颅内高压。在最后一次随访时，术后SNOT 22评分显著改善。所有患者在最近一次随访时皮瓣组织整合良好，无术后脑脊液漏。
ABMTF是一种新型随意皮瓣，由筛前动脉分支供血，对于颅底重建以及额隐窝与筛后动脉之间沿筛顶的前颅底脑脊液漏修补有效。该皮瓣用途广泛，并发症有限。
