Temporal Galeofascial Flap for Reconstruction After Transmaxillary Approaches to the Clival Region
| Autor: | Nicola Boari, Anthony J. Caputy, Martina Piloni, Pietro Mortini, Michele Bailo, Filippo Gagliardi |
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| Přispěvatelé: | Gagliardi, F., Boari, N., Piloni, M., Bailo, M., Caputy, A. J., Mortini, P. |
| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty Galeal-pericranial flap Skull Base Neoplasms Temporal muscle Surgical Flaps 03 medical and health sciences Clivus 0302 clinical medicine Cadaver Skull base reconstruction medicine Humans In patient Reconstructive Surgical Procedures Pterygopalatine fossa Transmaxillary approaches Skull Base Cerebrospinal Fluid Leak business.industry Endoscopy Fascia Pedicled Flap Surgery Temporal muscle fascia Skull medicine.anatomical_structure Cranial Fossa Posterior 030220 oncology & carcinogenesis Neurology (clinical) Nasal Cavity business 030217 neurology & neurosurgery |
| Zdroj: | World Neurosurgery. 134:e68-e74 |
| ISSN: | 1878-8750 |
| Popis: | Background A paramount concern after transmaxillary approaches has been skull base reconstruction. Regional pedicled flaps represent the best reconstructive option. We have described a technique to harvest a lateral-based multilayered vascularized flap for skull base reconstruction after resection of large tumors using the transmaxillary transpterygoid approach (TMTPA). Methods We performed a cadaver study using the TMTPA to harvest the combined temporal galeofascial flap (CTGF). The first layer, with major sealing capabilities, is composed by a temporoparietal galeal-pericranial flap. The second layer is composed by temporal muscle fascia to provide mechanical support for flap dural engrafting. Results The CTGF provides excellent coverage of both the clival dural lining and the ipsilateral pterygopalatine fossa structures (×1.6). The CTGF is pliable and easy to harvest. It offers great flexibility in flap content and design, providing a large quantity of vascularized tissue. The vascular pedicle derives from the superficial temporal vessels, which can ensure flap trophism. Conclusions CTGF represents an effective option as a regional multilayered pedicled flap for skull base reconstruction after resection of clival tumors using the TMTPA. The flap pedicle, owing to its anatomical location, will often be preserved even after repeated microsurgical or endoscopic procedures, providing a technical alternative for reconstruction even in patients who have undergone multiple surgeries with low residual availability of regional flaps. |
| Databáze: | OpenAIRE |
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