Disa J J, Rodriguez V M, Cordeiro P G
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Ann Plast Surg. 1998 Dec;41(6):633-9. doi: 10.1097/00000637-199812000-00009.
Surgical ablation for oncological disease of the lateral skull base can result in extensive defects, with exposed bone and dura. Inadequate coverage can result in meningitis, osteomyelitis, or delay in adjuvant therapy. Successful reconstruction requires well-vascularized soft tissue and often a large cutaneous component. This study evaluates the role of free tissue transfer in reconstruction of lateral skull base defects. This study is a retrospective review of all patients undergoing lateral skull base resection for oncological disease and immediate reconstruction from 1993 through 1997. There were 18 patients with a mean age of 57 years. The temporal bone was resected in 50% of patients. All defects were reconstructed with free tissue transfers from the following donor sites: rectus abdominis (N = 14), latissimus dorsi (N = 2), anterolateral thigh (N = 1), and lateral arm (N = 1). A cutaneous skin island was employed in all patients. Free flap survival was 100%. Flap-related complications occurred in 33% of patients but did not delay the onset of adjuvant therapy. Vein grafts were not required to lengthen the vascular pedicle. Two patients required split-thickness skin grafts because of inadequate size of the skin island. Four patients underwent flap revision for contour deformity a mean of 4 months postoperatively. Free tissue transfer is a highly reliable method of reconstructing lateral skull base defects in a single stage. Careful flap selection and design can minimize the need for skin and vein grafts. The rectus abdominis donor site is preferred because of its location, large skin island, and excellent vascular pedicle.
外侧颅底肿瘤性疾病的手术切除可能导致广泛的缺损，出现骨质和硬脑膜暴露。覆盖不充分可导致脑膜炎、骨髓炎或辅助治疗延迟。成功的重建需要血运丰富的软组织，通常还需要较大的皮肤成分。本研究评估了游离组织移植在外侧颅底缺损重建中的作用。本研究是一项对1993年至1997年间所有因肿瘤性疾病接受外侧颅底切除术并即刻进行重建的患者的回顾性研究。共有18例患者，平均年龄57岁。50%的患者颞骨被切除。所有缺损均采用来自以下供区的游离组织移植进行重建：腹直肌（n = 14）、背阔肌（n = 2）、股前外侧（n = 1）和上臂外侧（n = 1）。所有患者均采用皮肤岛状瓣。游离皮瓣存活率为100%。33%的患者发生了与皮瓣相关的并发症，但未延迟辅助治疗的开始。无需静脉移植来延长血管蒂。2例患者因皮肤岛状瓣尺寸不足需要进行断层皮片移植。4例患者术后平均4个月因外形畸形接受了皮瓣修复。游离组织移植是一期重建外侧颅底缺损的一种高度可靠的方法。仔细选择和设计皮瓣可将皮肤和静脉移植的需求降至最低。由于腹直肌供区的位置、较大的皮肤岛状瓣和优良的血管蒂，腹直肌供区是首选。
