Extended temporalis flap for skull base reconstruction

Chung, Soon Won; Hong, Jong Won; Lee, Won Jai; Kim, Yong Oock

doi:10.7181/acfs.2018.02278

Cited by 5 publications

(6 citation statements)

References 19 publications

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“…Також використовують локально переміщені тканини, зокрема скроневий і крилоподібний м'язи на ніжці, шкіру з лобної ділянки на ніжці. Переміщені скроневі та крилоподібні м'язи на ніжці є ефективними методами закриття дефектів дна ПЧЯ за рахунок масивних м'язових тканин, багатих на судини, що мають достатні механічні властивості, але не позбавлені недоліків (додатковий травмувальний чинник д ля ж увальних м'язів, косметичний дефект, збільшення тривалості операції) [13,14]. Ще одним методом є використання шкірного к лаптя на окісній ніжці, але невеликі розміри шкірного клаптя обмежують його використання для закриття дефектів дна ПЧЯ великого розміру, хоча перевагою методу є достатні механічні властивості.…”

Section: вступunclassified

Plastic closure of bone defects of anterior cranial fossa floor in surgery of benign and malignant craniofacial tumors

Palamar¹,

Huk²,

Okonskyi³

et al. 2022

Ukr Neurosurg J

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Objective: to analyze the results of using various methods of plastic closure of bone defects of the anterior cranial fossa (ACF) floor when removing craniofacial tumors of the ACF floor depending on the size of the defect. Materials and methods. A retrospective analysis of treatment outcomes of 122 patients with craniofacial tumors of the ACF floor was carried out. According to the nature of the lesions malignant craniofacial tumors were detected in 98 (80.3%) patients, and benign ones in 24 (19.7%) patients. The following neurosurgical approaches to craniofacial tumors of the ACF floor were used: bifrontal - in 58 (47.5%) patients, subcranial - in 49 (40.2%), transbasal Derome - in 8 (6.5%), frontotemporal - in 4 (3.25%), expanded endoscopic - in 3 (2.45%). In 52 (42.6%) cases, endoscopic endonasal assistance was used, most often in the case of plasty of large ACF floor defects to revise the surgical defect, assess the sufficiency of plasty and tamponade of the nasal cavity with balloon catheters. Results. Patients were divided into groups depending on the bone defect of the ACF floor: median - in 27 (22.1%), middle-expanded - in 71 (58.2%), middle-lateral - in 24 (19.7%). The following types of plasty of the bone defect of the ACF floor were used: pedicle flap - 83 (68.0%) cases, free flap - 22 (18.1%), pedicled periosteal flap with reinforcement - 17 (13.9%). Postoperative complications occurred in 17 (13.9%) patients: nasal liquorrhea in 10 (8.2%) patients (of which 6 underwent reoperation to eliminate it), in 7 patients it was complicated by meningoencephalitis, in other 7 (5.7 %) - meningoencephalitis without signs of nasal cerebrospinal fluid. Postoperative mortality was 0.71% (1 patient). The frequency of nasal cerebrospinal fluid in the group of plasty using a free flap was 13.6% (3 cases), meningoencephalitis - 4.5% (1 observation), in the group of plasty using pedicle flap - 4.8% (4 cases) and 6.0% (5 observations), in the group of plasty using a pedicle flap with reinforcement - 17.6% (3 cases) and 11.7% (2 observations). In 33 (27.1%) cases the use of the author's method of bone defect plasty of the ACF floor with duplication of complications were not registered. Conclusions. Significant size and spread of bone defects of the ACF floor increase the risk of postoperative complications. The use of free flaps for plasty of the bone defect of the ACF floor is ineffective and is associated with a high risk of complications. The proposed method of plasty of the posterior parts of the ACF floor by duplication of the periosteal flap promotes the sealing of the posterior parts, where suturing causes certain difficulties. Reinforcement of plasty from the side of the nasal cavity due to endoscopic technique using tamponade or balloon catheters reduces the incidence of postoperative complications.

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Section: вступunclassified

Plastic closure of bone defects of anterior cranial fossa floor in surgery of benign and malignant craniofacial tumors

Palamar¹,

Huk²,

Okonskyi³

et al. 2022

Ukr Neurosurg J

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“…A coronal incision is made. 13 The scalp flap is dissected in the subfollicular plane, exposing the STF and the GC. The TM flap is elevated with the ADTA, including the STF and the GC, lying beyond the muscle.…”

Section: Temporalis Extended Myofascial Flapmentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9][10][11][12] Muscle combination with different regional tissues, that is, deep and superficial muscle fascia (deep temporal fascia [DTF], superficial temporal fascia [STF]), pericranium, galea capitis (GC), and bone graft (chimeric flaps), has enriched flap versatility and robustness and has enabled multilayered reconstruction. [13][14][15] Flap extension toward not always wellvascularized territories might impair flap supply. It has to be kept in mind that some of the tissues (mostly GC and bone grafts) might not always be adequately vascularized, possibly representing watershed vascular territories (between superficial temporal artery [STA] and deep temporal artery [DTA]), thus potentially jeopardizing flap viability and reliability.…”

Section: Introductionmentioning

confidence: 99%

Temporal Flaps in Head and Neck Reconstructive Surgery: A Systematic Review of Surgical Techniques

Gagliardi

Snider

Pompeo

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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The temporal region is a great source of vascularized flap, providing extremely variable and versatile options for reconstruction in head and neck surgery. Its popularity has led to the conception of a large variety of different flaps, in terms of contents and design. Temporal flaps are highly pliable and flexible, providing adequate bulk to obliterate dead spaces and improving engraftment, thus facilitating wound healing. The need to access different anatomical compartments, often far from the original flap anatomical site, has led surgeons to develop techniques to enlarge pedicles and bulk, by reverting and splitting flaps' contents, as well as through partial mandibular and zygomatic resection. To further increase versatility, a multilayered combination of different regional tissues and muscle segmentation techniques has been described. Historically, each flap has had its own proponents and opponents, but a pointy review systematizing techniques and comparatively analyzing different flaps was still missing in the literature. The field of use of some flaps has been progressively limited by the increasing relevance of free tissue transfers, which nowadays may provide success rates up to 95% with a constrained morbidity, thus offering an effective alternative, when available. Given the wide range of reconstructive strategies based on temporal flaps, there is still a great debate on nomenclature and surgical techniques. The present study systematizes the topic, classifying regional flaps according to contents and indications. Harvesting techniques are described stepwise and schematically illustrated, thus offering an indispensable tool to the armamentarium of reconstructive surgeons.

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“…Local flaps, distant pedicled fasciocutaneous flaps, and muscle flaps (e.g., galeal and temporalis muscle flaps) have traditionally provided vascularized tissue for dural seals [3][4][5]. The choice of a reconstructive technique depends on multiple factors (e.g., defect size and the involvement of an irradiated field).…”

Section: Introductionmentioning

confidence: 99%

Anterior skull base reconstruction using an anterolateral thigh free flap

Kim

Lee

Chang

et al. 2021

Arch Craniofac Surg

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Background: Galeal or temporalis muscle flaps have been traditionally used to reconstruct skull base defects after tumor removal. Unfortunately, these flaps do not provide sufficient vascularized tissue for a dural seal in extensive defects. This study describes the successful coverage of large skull base defects using anterolateral thigh (ALT) free flaps.Methods: This retrospective study included five patients who underwent skull base surgery between June 2018 and June 2021. Reconstruction was performed using an ALT free flap to cover defects that included the intracranial space and extended to the frontal sinus and cribriform plate.Results: There were no major complications, such as ascending infections or cerebrospinal leakage. Postoperative magnetic resonance imaging showed that the flaps were well-maintained in all patients.Conclusion: Successful reconstruction was performed using ALT free flaps for large anterior skull base defects. In conclusion, the ALT free flap is an effective option for preventing communication between the nasal cavity and the intracranial space.

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Extended temporalis flap for skull base reconstruction

Cited by 5 publications

References 19 publications

Plastic closure of bone defects of anterior cranial fossa floor in surgery of benign and malignant craniofacial tumors

Plastic closure of bone defects of anterior cranial fossa floor in surgery of benign and malignant craniofacial tumors

Temporal Flaps in Head and Neck Reconstructive Surgery: A Systematic Review of Surgical Techniques

Anterior skull base reconstruction using an anterolateral thigh free flap

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