A novel reconstructive technique after endoscopic expanded endonasal approaches: Vascular pedicle nasoseptal flap
A novel reconstructive technique after endoscopic expanded endonasal approaches: Vascular pedicle nasoseptal flap
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DOI：
10.1097/01.mlg.0000234933.37779.e4
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发表时间：
2006-10-01
期刊：
影响因子：
2.6
通讯作者：
Mintz, Arlan
中科院分区：
文献类型：
--
作者：
Hadad, Gustavo;Bassagasteguy, Luis;Mintz, Arlan
背景：在鼻内颅底手术后前、腹侧颅底有较大硬脑膜缺损的患者，重建术后脑脊液漏的风险很大。带血管组织重建是促进快速愈合的理想方法，尤其是在接受照射的患者。方法：以鼻中隔后动脉分支鼻中隔粘骨膜和粘骨膜为蒂的鼻中隔神经营养血管瓣(Hadad-BassagasteGuy瓣[HBF])。对在阿根廷罗萨里奥大学和匹兹堡大学医学中心接受鼻内颅底手术的患者进行了回顾，以确定哪些患者接受了带血管的鼻中隔粘膜瓣重建。结果：43例接受鼻内颅底手术的患者均采用鼻中隔粘膜瓣修复。2例(5%)术后脑脊液漏患者成功应用局灶性脂肪移植治疗。在这一系列的患者中，我们没有遇到感染或伤口并发症。1例患者出现鼻后动脉出血。用电灼术控制这一点，保留了皮瓣血供。结论：HBF是修复前、中、斜面及鞍旁颅底缺损的一种通用、可靠的技术。它的使用大大降低了鼻腔颅底手术后脑脊液漏的发生率，并被推荐用于大型硬脑膜缺损的重建和术后放射治疗。
Background: In patients with large dural defects of the anterior and ventral skull base after endonasal skull base surgery, there is a significant risk of a postoperative cerebrospinal fluid leak after reconstruction. Reconstruction with vascularized tissue is desirable to facilitate rapid healing, especially in irradiated patients. Methods: We developed a neurovascular pedicled flap of the nasal septum mucoperiosteum and mucoperichondrium based on the nasoseptal artery, a branch of the posterior septal artery (Hadad-Bassagasteguy flap [HBF]). A retrospective review of patients undergoing endonasal skull base surgery at the University of Rosario, Argentina, and the University of Pittsburgh Medical Center was performed to identify patients who were reconstructed with a vascularized septal mucosal flap. Results: Forty-three patients undergoing endonasal cranial base surgery were repaired with the septal mucosal flap. Two patients with postoperative cerebrospinal fluid leaks (5%) were successfully treated with focal fat grafts. We encountered no infectious or wound complications in this series of patients. One patient experienced a posterior nose bleed from the posterior nasal artery. This was controlled with electrocautery and the flap blood supply was preserved. Conclusion: The HBF is a versatile and reliable reconstructive technique for defects of the anterior, middle, clival, and parasellar skull base. Its use has resulted in a sharp decrease in the incidence of postoperative cerebrospinal fluid leaks after endonasal skull base surgery and is recommended for the reconstruction of large dural defects and when postoperative radiation therapy is anticipated.