Quantitative determination of the optimal temporoparietal fascia flap necessary to repair skull‐base defects

Autor:	Mindy Rabinowitz, Adam Luginbuhl, Chandala Chitguppi, Gurston Nyquist, Alan Siu, Christopher J. Farrell, James J. Evans, Ryan A. Rimmer, Sanjeet Rangarajan, Marc Rosen
Rok vydání:	2020
Předmět:	Skull Base Pterygomaxillary fissure business.industry Cribriform plate Anatomy Plastic Surgery Procedures Surgical Flaps Quantitative determination 03 medical and health sciences Skull 0302 clinical medicine Temporoparietal fascia medicine.anatomical_structure Cranial Fossa Posterior 030228 respiratory system Otorhinolaryngology Clivus Humans Immunology and Allergy Medicine Fascia 030223 otorhinolaryngology Cadaveric spasm business Anterior skull base
Zdroj:	International Forum of Allergy & Rhinology. 10:1249-1254
ISSN:	2042-6984 2042-6976
DOI:	10.1002/alr.22609
Popis:	BACKGROUND The ability to reconstruct large cranial base defects has greatly improved with the development of pedicled vascularized flaps. The temporoparietal fascia flap (TPFF) is a viable alternative to the Hadad-Bassagasteguy nasoseptal flap for large ventral skull-base defects. This study aims to characterize the size of the TPFF necessary for optimal ventral skull-base reconstruction. METHODS Eleven formaldehyde-fixed cadaveric heads were used to harvest TPFF of varying heights on each side (total = 22). TPFF was passed through the pterygomaxillary fissure (PMF) to the ventral skull base to assess its coverage. For a subgroup of 12 sides, the TPFF was trimmed to determine the minimum height necessary for coverage. RESULTS The TPFF height was (mean ± standard deviation [SD]) 14.72 ± 1.02 cm (range, 12.5 to 16.5 cm) and width was 8.43 ± 1.05 cm (range, 6 to 10.5 cm). The distance from the TPFF pedicle through the PMF was 5.8 ± 0.5 cm (range, 5 to 6.5 cm). All TPFF flaps provided complete ipsilateral coverage of clival defects, and all but 1 covered the entire clivus. All TPFF flaps, when rotated anteriorly, provided coverage up to the cribriform plate. The minimum TPFF height necessary for complete coverage of cribriform defects and ventral defects up to the planum sphenoidale was 12 cm. TPFF height for specimens with and without complete ventral skull-base coverage was significantly different (p < 0.0001). CONCLUSION The TPFF is a versatile alternative to the nasoseptal flap and a height of at least 12 cm can provide enough coverage for all ventral skull base defects.
Databáze:	OpenAIRE
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