游离穿支皮瓣修复晚期颅底肿瘤手术缺损

目的探讨应用游离穿支皮瓣修复技术,对晚期颅底肿瘤术后缺损的修复。方法回顾性分析2004年10月～2011年5月采用游离穿支皮瓣一期修复14例晚期颅底肿瘤术后缺损患者的临床资料,其中采用腹壁下深动脉穿支皮瓣8例,股前外侧皮瓣5例,胸背动脉穿支皮瓣1例。结果 14例皮瓣中13例游离穿支皮瓣成活,1例皮瓣坏死,成活率为93%。术后并发脑脊液鼻漏3例,其中2例继发颅内感染。供区均直接缝合关闭并一期愈合,未发现并发症。结论游离穿支皮瓣保留了供区的肌肉、筋膜和神经,将供区的并发症降到最低限度,同时涉及皮肤或黏膜手术缺损的修复,适用于颅底晚期复发肿瘤,是颅底缺损修复新的可靠技术。

Free perforator flaps transfer for skull base reconstruction of advanced oncological defects

Objective To evaluate the application of perforator flaps to the skull base reconstruction of advanced oncological defects. Methods Clinical data of 14 patients received reconstruction of skull base tumor ablation defects with perforator flaps from Oct. 2004 to May 2011 was analyzed retrospectively. There were 14 flaps including 8 deep inferior epigastric artery perforator （DIEA） flaps, 5 anterolateral thigh （ALT） flaps and 1 thoracodorsal artery perforator （TAP） flap. All patients had recurrent advanced neoplasms with previous radiation therapy or surgery history. Results The overall success rate was 93 % （ 13/14 ）. One ALT flap got necrotic. Three patients （20 % ） had cerebrospinal fluid fistula and 2 of them developed infection of central nervous system. No complications such as wound dehiscence, weakness and hernia were observed in the donor sites. Conclusions Perforator flaps are new and reliable for reconstruction of advanced oncological skull base defects. With advantages of minimal donor site morbidity, the perforator flap may be one of the preferred choices.