Galeal-pericranial flaps in head and neck reconstruction anatomy and application

Horowitz, Jed H.; Persing, John A.; Nichter, Larry S.; Morgan, Raymond F.; Edgerton, Milton T.

doi:10.1016/0002-9610(84)90375-1

Cited by 89 publications

(32 citation statements)

References 17 publications

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“…14,18,20 Classic repair of the anterior skull base uses an anteriorly based pericranial flap as the primary means to repair anterior cranial floor defects due to multiple etiologies. 3,21,23,33,35 Its popularity can be attributed to various factors. It is an easy flap to harvest, and it does not often require additional incisions.…”

Section: Discussion Pericranial Flap Designmentioning

confidence: 99%

Surgical anatomy and utility of pedicled vascularized tissue flaps for multilayered repair of skull base defects

Safavi–Abbasi

Komune

Archer

et al. 2016

JNS

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OBJECT The objective of this study was to describe the surgical anatomy and technical nuances of various vascularized tissue flaps. METHODS The surgical anatomy of various tissue flaps and their vascular pedicles was studied in 5 colored silicone-injected anatomical specimens. Medical records were reviewed of 11 consecutive patients who underwent repair of extensive skull base defects with a combination of various vascularized flaps. RESULTS The supraorbital, supratrochlear, superficial temporal, greater auricular, and occipital arteries contribute to the vascular supply of the pericranium. The pericranial flap can be designed based on an axial blood supply. Laterally, various flaps are supplied by the deep or superficial temporal arteries. The nasoseptal flap is a vascular pedicled flap based on the nasoseptal artery. Patients with extensive skull base defects can undergo effective repair with dual flaps or triple flaps using these pedicled vascularized flaps. CONCLUSIONS Multiple pedicled flaps are available for reconstitution of the skull base. Knowledge of the surgical anatomy of these flaps is crucial for the skull base surgeon. These vascularized tissue flaps can be used effectively as single or combination flaps. Multilayered closure of cranial base defects with vascularized tissue can be used safely and may lead to excellent repair outcomes.

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Section: Discussion Pericranial Flap Designmentioning

confidence: 99%

Surgical anatomy and utility of pedicled vascularized tissue flaps for multilayered repair of skull base defects

Safavi–Abbasi

Komune

Archer

et al. 2016

JNS

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“…This combination forms a resilient tissue flap with a rich vascular supply. 27 This flap is highly versatile, provides a large surface area with a superior arc of rotation, and may be used with minimal donor site morbidity and excellent cosmetic outcomes. There is scant literature evaluating utilization and classification of combination flaps in traumatic repairs.…”

Section: Fracture Classification and Treatment Strategiesmentioning

confidence: 99%

Extensive traumatic anterior skull base fractures with cerebrospinal fluid leak: classification and repair techniques using combined vascularized tissue flaps

Archer¹,

Sun

Bonney³

et al. 2016

JNS

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OBJECT This article introduces a classification scheme for extensive traumatic anterior skull base fracture to help stratify surgical treatment options. The authors describe their multilayer repair technique for cerebrospinal fluid (CSF) leak resulting from extensive anterior skull base fracture using a combination of laterally pediculated temporalis fascial-pericranial, nasoseptal-pericranial, and anterior pericranial flaps. METHODS Retrospective chart review identified patients treated surgically between January 2004 and May 2014 for anterior skull base fractures with CSF fistulas. All patients were treated with bifrontal craniotomy and received pedicled tissue flaps. Cases were classified according to the extent of fracture: Class I (frontal bone/sinus involvement only); Class II (extent of involvement to ethmoid cribriform plate); and Class III (extent of involvement to sphenoid bone/sinus). Surgical repair techniques were tailored to the types of fractures. Patients were assessed for CSF leak at follow-up. The Fisher exact test was applied to investigate whether the repair techniques were associated with persistent postoperative CSF leak. RESULTS Forty-three patients were identified in this series. Thirty-seven (86%) were male. The patients’ mean age was 33 years (range 11–79 years). The mean overall length of follow-up was 14 months (range 5–45 months). Six fractures were classified as Class I, 8 as Class II, and 29 as Class III. The anterior pericranial flap alone was used in 33 patients (77%). Multiple flaps were used in 10 patients (3 salvage) (28%)—1 with Class II and 9 with Class III fractures. Five (17%) of the 30 patients with Class II or III fractures who received only a single anterior pericranial flap had persistent CSF leak (p < 0.31). No CSF leak was found in patients who received multiple flaps. Although postoperative CSF leak occurred only in high-grade fractures with single anterior flap repair, this finding was not significant. CONCLUSIONS Extensive anterior skull base fractures often require aggressive treatment to provide the greatest long-term functional and cosmetic benefits. Several vascularized tissue flaps can be used, either alone or in combination. Vascularized flaps are an ideal substrate for cranial base repair. Dual and triple flap techniques that combine the use of various anterior, lateral, and nasoseptal flaps allow for a comprehensive arsenal in multilayered skull base repair and salvage therapy for extensive and severe fractures.

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“…For smaller defects, most commonly used flap is pericranial flap 50,51 or galeopericranial flap. [52][53][54] Pericranial flap consists of periosteum and sub-aponeurotic connective tissue and is based on supratrocheal or supraorbital arteries. This flap can also be based laterally on branches of deep temporal artery.…”

Section: Local and Regional Flapsmentioning

confidence: 99%

Anterior skull base surgery

Kuriakose

Trivedi

Kekatpure

2010

Indian J Surg Oncol

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The basic principle of anterior skull base surgery is to provide adequate exposure to enable three dimensional resection of skull base tumors. Negative surgical margins, which is within the control of surgeon, is the principle prognostic factor in anterior skull base tumors. Open skull base approaches is the standard of care for malignant anterior skull base tumors. Benign lesions may be resected by alternate minimally invasive approaches. Advances in anterior skull base surgery, in particular the facial translocation approaches allows wide exposure of the tumors with minimal retraction of the brain. The outcome of anterior skull base tumors have steadily increased over the years with disease free survival comparable to other malignant neoplasm of the head and neck region. This review described various surgical approaches and pertaining anatomy and pathology of anterior skull base tumors.

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Galeal-pericranial flaps in head and neck reconstruction anatomy and application

Cited by 89 publications

References 17 publications

Surgical anatomy and utility of pedicled vascularized tissue flaps for multilayered repair of skull base defects

Surgical anatomy and utility of pedicled vascularized tissue flaps for multilayered repair of skull base defects

Extensive traumatic anterior skull base fractures with cerebrospinal fluid leak: classification and repair techniques using combined vascularized tissue flaps

Anterior skull base surgery

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