The turbinal flap: an additional option for anterior skull base reconstruction. Cadaveric feasibility study and case report

Schreiber, Alberto; Mattavelli, Davide; Ferrari, Marco; Rampinelli, Vittorio; Lancini, Davide; Belotti, Francesco; Rodella, Luigi Fabrizio; Nicolai, Piero

doi:10.1002/alr.21857

Cited by 15 publications

(9 citation statements)

References 11 publications

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“…The mean surface area for the EEM (8.03 [1.36] cm 2 ) in the cadaveric specimen is similar to that obtained with free middle turbinate grafts, 14 but smaller than the simple (12.3 [2.3] cm 2 ) or extended (28.8 [3.3] cm 2 ) nasal floor and inferior meatus flap, as reported by Santamaria‐Gadea et al 15 However, they have the limitation of the mucosal surface necessary for the rotation of the pediculated flap.…”

Section: Discussionsupporting

confidence: 73%

Radioanatomical study of the extended free nasal floor mucosal graft and its clinical applications

González‐García

Moreno‐Luna

Palacios-García

et al. 2020

Laryngoscope Investig Oto

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Objectives: To perform a radio-anatomical evaluation of the nasal cavity floor free mucosal graft (endonasal extended mucoplasty, EEM) to repair mucosal defects after an extended ethmoid-sphenoidotomy. Methods: A human cadaveric study (radiological and anatomical dissection) and an in vivo study in surgical patients with CRSwNP were performed. The EEM areas were compared between 3D reconstruction from CT scans and anatomical/surgical dissections, both in cadaver specimens and in patients. Feasibility was assessed by correlation between the EEM area on CT scans and when harvested in cadavers and when grafted in patients. Usefulness was assessed by the degree of coverage of the EEM in the surface exposed after an extended ethmoid-sphenoidotomy. Both feasibility and usefulness were assessed in cadaveric specimens (n = 15) and patients (n = 4). Results: Fifteen cadaveric specimens and 4 patients with bilateral CRSwNP were included. The mean (SD) areas obtained in the cadaveric radiological and anatomical studies were 9.44 (2.07) cm 2 and 8.03 (1.36) cm 2 , respectively (intraclass correlation coefficient 0.59, moderate correlation), and in 3D reconstruction for operated patients were 10.32 (0.98) cm 2 and 11.27 (2.44) cm 2 , respectively. The coverage of the ethmoidal roof in the cadaveric dissection study was 100%, from the anterior ethmoidal artery to the posterior ethmoidal artery, covering the planun sphenoidale up to 75% in the case series. In 87.5% of the cases, up to 50% of the papiracea lamina was covered. Jaime González-García and Ramón Moreno-Luna contributed equally as first authors.

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Section: Discussionsupporting

confidence: 73%

Radioanatomical study of the extended free nasal floor mucosal graft and its clinical applications

González‐García

Moreno‐Luna

Palacios-García

et al. 2020

Laryngoscope Investig Oto

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“…However, the safe and effective dose of fluorescence technology still needs to be further explored 39 . Many articles have evaluated the effectiveness of flap transplantation by conducting retrospective studies on wound size, degree of vascularization, surgical technique, and complications 40‐42 . In addition, studies have shown that vascularization can also promote nerve regeneration and repair, providing a healthy tissue bed for the flap 43 .…”

Section: Discussionmentioning

confidence: 99%

“…39 Many articles have evaluated the effectiveness of flap transplantation by conducting retrospective studies on wound size, degree of vascularization, surgical technique, and complications. [40][41][42] In addition, studies have shown that vascularization can also promote nerve regeneration and repair, providing a healthy tissue bed for the flap. 43 We found it interesting that in addition to the common pedicled flap, musculocutaneous flap, fascia flap, and flap, omentum flap, as a free flap, has become a valuable tool in reconstruction.…”

Section: Hotspot Analysis Of Research Pertaining To Vascularization A...mentioning

confidence: 99%

Angiogenesis and flap‐related research: A bibliometric analysis

Tong

Xiao

et al. 2023

International Wound Journal

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Adequate blood supply, a prerequisite for flap survival after grafting, makes angiogenesis of the flap the biggest problem to be solved. Researches have been conducted around vascularisation in correlation with flap grafting. However, bibliometric analyses systematically examining this research field are lacking. As such, we herein sought to conduct comprehensive comparative analyses of the contributions of different researchers, institutions, and countries to this research space in an effort to identify trends and hotspots in angiogenesis and vascularisation in the context of flap grafting. Publications pertaining to angiogenesis and vascularisation in the context of flap grafting were retrieved from the Web of Science Core Collection. References were then analysed and plotted using Microsoft Excel 2019, VOSviewer, and CiteSpace V. In total, 2234 papers that were cited 40 048 times (17.63 citations/paper) were included in this analysis. The greatest number of studies were from the United States, with these studies exhibiting both the highest number of citations (13 577) and the greatest overall H‐index (60). For The institutions that published the greatest number of studies were WENZHOU MEDICAL UNIVERSITY (681), while UNIVERSITY OF ERLANGEN NUREMBERG has the highest number of citations (1458), and SHANGHAI JIAO TONG UNIVERSITY holds the greatest overall H‐index (20). The greatest number of studies in this research space were published by Gao WY, while Horch RE was the most commonly cited researcher in the field. The VOS viewer software clustered relevant keywords into three clusters, with clusters 1, 2, 3, and 4 corresponding to studies in which the keywords ‘anatomy’, ‘survival’, ‘transplantation’, ‘therapy’ most frequently appeared. The most promising research hotspot‐related terms in this field included ‘autophagy’, ‘oxidative stress’, ‘ischemia/reperfusion injury’, which exhibited a most recent average appearing year (AAY) of 2017 and after. Generally speaking, the results of this analysis indicate that the number of articles exploring angiogenesis and flap‐related research has risen steadily, with the United States and China being the two countries publishing the greatest proportion of studies in this field. The overall focus of these studies has shifted away from ‘infratest and tissue engineering’ towards ‘mechanisms’. In the future, particular attention should be paid to emerging research hotspots, which include ‘ischemia/reperfusion injury’ and treatments for promoting vascularization, such as ‘platelet‐rich plasma’. In light of these findings, funding agencies should continue increasing their investment in the exploration of the concrete mechanisms and interventional therapeutic relevance of angiogenesis during flap transplantation.

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“…This flap is adequate to cover defects along the entire ethmoid roof up to a size of 8cm 2 . It can also cover the medial orbital wall and medial portion of the roof of maxillary sinus ( 38 ).…”

Section: Type Of Reconstructions In Sinonasal Tumors Surgerymentioning

confidence: 99%

Interdisciplinary challenges and aims of flap or graft reconstruction surgery of sinonasal cancers: What radiologists and radiation oncologists need to know

Carsuzaa

Vérillaud

Marcy³

et al. 2022

Front. Oncol.

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In sinonasal cancer surgery, a fundamental challenge is to understand the postoperative imaging changes after reconstruction. Misinterpretation of post-operative imaging may lead to a misdiagnosis of tumor recurrence. Because radiotherapy planning is based on imaging, there are many gaps in knowledge to be filled in the interpretation of postoperative imaging to properly define radiotherapy tumor volumes in the presence of flaps. On the other hand, radiotherapy may be responsible for tissue fibrosis or atrophy, the anatomy of the reconstructed region and the functional outcomes may change after radiotherapy compared to surgery alone. This narrative review illustrates the interdisciplinary aims and challenges of sinonasal reconstructive surgery using flaps or grafts. It is particularly relevant to radiologists and radiation oncologists, at a time when intensity modulated radiotherapy and proton therapy have the potential to further contribute to reduction of morbidity.

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The turbinal flap: an additional option for anterior skull base reconstruction. Cadaveric feasibility study and case report

Abstract: The main indication for the TF is the repair of anterior skull base defects involving the ethmoid roof. Its advantages include the double pedicle, rich vascularization, autonomy from the maxillary artery system, and preservation of the olfactory mucosa.

Cited by 15 publications

References 11 publications

Radioanatomical study of the extended free nasal floor mucosal graft and its clinical applications

Radioanatomical study of the extended free nasal floor mucosal graft and its clinical applications

Angiogenesis and flap‐related research: A bibliometric analysis

Interdisciplinary challenges and aims of flap or graft reconstruction surgery of sinonasal cancers: What radiologists and radiation oncologists need to know

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