Locoregional and Microvascular Free Tissue Reconstruction of the Lateral Skull Base

Arnaoutakis, Demetri; Kadakia, Sameep; Abraham, Manoj T.; Lee, Thomas; Ducic, Yadranko

doi:10.1055/s-0037-1606556

Cited by 16 publications

(17 citation statements)

References 40 publications

(36 reference statements)

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“…The thickness and volume of this flap are easily adjusted to match the defect. ALT flap can be harvested without changing intraoperative patient positioning allowing a single-staged surgery by the donor-site team and recipient-site team [24].…”

Section: Discussionmentioning

confidence: 99%

Anterolateral thigh free flap in reconstruction of lateral skull base defects after oncological resection

Trojanowski

Szymański

Trojanowska

et al. 2019

Eur Arch Otorhinolaryngol

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PurposeEvaluation of the utility of the free anterolateral thigh flap reconstruction of the defects resulting from radical temporal bone resection in the management of lateral skull base malignancies in a single institution.MethodsAn analysis of 17 en bloc subtotal petrosectomies for removal of malignant tumours was performed. There were 12 squamous cell carcinomas, 4 basal cell carcinomas and 1 adenoid cystic carcinoma. The tumours were staged with the University of Pittsburgh TNM system. In all patients, the lateral temporal bone with the preservation of the petrous apex and carotid artery was performed. All patients had parotid gland resection. The post-resection defect was reconstructed with an ALT free flap.ResultsTumour radical resection and defect reconstruction with an ALT flap was achieved in all patients without intraoperative complications. The transplants were harvested as fasciocutaneous flaps, 11 perfused by musculocutaneous and 6 by septocutaneous perforators. The ALT flaps had a mean pedicle length of 8 cm (6–12 cm), and the flap size ranged between 6 × 15 cm and 15 × 30 cm. The flaps were supplied by nine facial, five occipital and three maxillary arteries. Recipient-site veins included eight internal jugular, seven facial, one retromandibular and one external jugular vein. All arterial pedicles were anastomosed in an end-to-end manner. The veins were anastomosed with interrupted sutures and in 11 cases with Synovis-Coupler® devices. All the flap transfers were performed successfully. Three patients experienced postoperative complications.ConclusionsThe ALT flap proved to be effective for covering large temporal skull base defects resulting from the radical removal of temporal bone malignancies. The functional and cosmetic results were acceptable with a low complication rate.

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Section: Discussionmentioning

confidence: 99%

Anterolateral thigh free flap in reconstruction of lateral skull base defects after oncological resection

Trojanowski

Szymański

Trojanowska

et al. 2019

Eur Arch Otorhinolaryngol

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“…The temporalis muscle pedicled flap was used when the surgical defect was small and it was possible to rotate it into the defect without compromising the blood vessels in the pedicle. The temporalis muscle pedicled flap is limited by the distance it can be extended due to its attachment to the coronoid process of the mandible . A fascia lata flap was used to reconstruct the separation between the cranial content and the facial content in cases of exposed dura after craniotomy …”

Section: Resultsmentioning

confidence: 99%

“…Although the rectus abdominis free flap had been used in the past due to its bulkiness and reliable long pedicle, currently, the ALT free flap is more popular because it has the same advantages as the rectus abdominis, with lower morbidity, a high versatility of application, allowing working in two teams at the same time, thereby reducing operation time . The temporalis muscle pedicled flap was used when the surgical defect was small and it was possible to rotate it into the defect without compromising the blood vessels in the pedicle.…”

Section: Resultsmentioning

confidence: 99%

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Surgical approaches for infratemporal fossa tumor resection: Fifteen years' experience of a single center

et al. 2019

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Background The aims of this study were to report our center's experience with infratemporal fossa (ITF) tumors, to review the treatment modalities and outcomes. Methods Data of patients that underwent resection of ITF tumors in a single tertiary referral medical center were collected and analyzed. Results Sixty‐three patients were included. Sarcoma was the most common pathology (18; 29%). The most common surgical approach was the preauricular‐orbitozygomatic approach (24; 38%), followed by endoscopic, craniofacial resection, and combined approaches. Forty‐seven patients (75%) required reconstruction, 23 (49%) involving free tissue transfer. Thirty‐five patients (76%) with malignant lesions required adjuvant therapy consisting of radiotherapy, chemotherapy, or both. Thirty‐three patients suffered from complications related to surgery or adjuvant therapy. The three‐ and five‐years survival rates for malignancy were 82% and 66%, respectively. Conclusion Complete surgical resection of ITF involving tumors is feasible, providing good long‐term survival. Multidisciplinary approach is the key for success.

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“…The utilization of a particular free flap for this reconstruction tends to rely on the experience and preference in the hands of a particular surgeon; this may range between the rectus abdominis, ALT, or radial forearm free flaps. 38…”

Section: Lateral Skull Base Reconstructionmentioning

confidence: 99%

Management of Large Facial Defects

et al. 2020

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There is considerable variation in the surgical management of patients with large facial defects after excision of skin malignancy. The surrounding facial subunits as well as local, regional, and distant soft-tissue flaps can be considered in more complicated facial defects. We place an emphasis on the versatility of adjacent tissue advancement and transposition flaps in the treatment of these defects. We also focus on the secondary reconstructive efforts necessary to achieve the best functional and aesthetic outcomes for patients.

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Locoregional and Microvascular Free Tissue Reconstruction of the Lateral Skull Base

Cited by 16 publications

References 40 publications

Anterolateral thigh free flap in reconstruction of lateral skull base defects after oncological resection

Anterolateral thigh free flap in reconstruction of lateral skull base defects after oncological resection

Surgical approaches for infratemporal fossa tumor resection: Fifteen years' experience of a single center

Management of Large Facial Defects

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