The versatility of the temporoparietal fascia flap in head and neck reconstruction

Collar, Ryan M.; Zopf, David; Brown, David L.; Fung, Kevin; Kim, Jennifer

doi:10.1016/j.bjps.2011.05.003

Cited by 59 publications

(31 citation statements)

References 43 publications

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“…Other clinical findings are summarized in Table 2. The patients' neurological presentation varied widely; the mean Glasgow Coma Scale score was 9.8 (range [3][4][5][6][7][8][9][10][11][12][13][14][15].…”

Section: Results Patient Populationmentioning

confidence: 99%

“…25,55,58 Another widely used flap is the temporoparietal fascia flap, which has been well described in plastic and reconstructive surgery for the head and neck; however, reports of its use in the skull base are sparse. 2,7,9,48,57 To evaluate the evolution of our neurosurgical techniques and treatment outcomes for comminuted anterior skull base fractures, we collected and analyzed data on patients who underwent surgical repair of extensive anterior skull base fractures. In this series, we describe the use of various combined vascularized tissue flaps for multilayered repairs of the anterior skull base.…”

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confidence: 99%

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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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Section: Results Patient Populationmentioning

confidence: 99%

mentioning

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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“…Using this approach during surgery on maxilla for locally advanced tumours provides more detailed visualisation of facial skull structures which facilitates radical operation [5][6][7] . Apparent contradiction is tumour invasion in facial soft tissues.…”

Section: Discussionmentioning

confidence: 99%

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2013

Annals of Oral and Maxillofacial Surgery

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IntroductionTendency of cancer of the mucous membrane of the maxillary sinus to persistent recurrence, relatively high resistance of the most of them to radio-and drug therapy define complexity of treatment of this oncological pathology. At the present time expanded surgery in combination with chemo-and radiotherapy allows achieving high oncological und functional outcomes. This paper reports a case of surgical treatment of maxillary sinus cancer. Case ReportHere we describe the case of a 28-yearold patient T. with locally advanced low differentiated squamous cell carcinoma of the mucous membrane of the maxillary sinus. During the first stage of complex treatment four courses of chemotherapy were held. Further preoperative radiotherapy ROD-10 was conducted. Then bloc-resection of the left upper jaw with left orbital exenteration, plastic with displaced muscle graft, reimplantation of facial tissue with microsurgical grafting of the facial nerve on the left was performed. No complications were observed. Followup was 6 months long. Cosmetic and functional results are satisfactory. Discussion Using this approach during surgery on maxilla for locally advanced tumours provides more detailed visualisation of facial skull structures

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“…For this reason, pedicled flaps, such as the anteriorly based pericranial, temporoparietal fascial, temporalis muscle, and galeopericranial flaps, are frequently used to reconstruct the cranial base. 6,7,9,[15][16][17]19,23,24,26,31,32,37 More recently, endoscopic endonasal approaches have been popularized and a vascular pedicled flap of the nasal septum based on the nasoseptal artery (Hadad-Bassagasteguy flap or nasoseptal flap [NSF]) has also been introduced for skull base repair and is used extensively. 17,24 The aim of this report is to detail the surgical and anatomical properties of these versatile pedicled tissue flaps and to establish the technical nuances for multilayered skull base repair in clinical cases where these flaps may be used in combination.…”

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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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The versatility of the temporoparietal fascia flap in head and neck reconstruction

Cited by 59 publications

References 43 publications

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

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

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

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