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Intracranial application of free fasciocutaneous flaps in a novel sandwich technique for skull base reconstruction

Largo, R. D. and Schaefer, D. J. and Krueger, J. and Harschnitz, O. and Zimmerer, S. and Jaquiéry, C. and Haug, M. D. and Mariani, L. and Kunz, C.. (2011) Intracranial application of free fasciocutaneous flaps in a novel sandwich technique for skull base reconstruction. International journal of oral and maxillofacial surgery, Vol. 40, H. 9. pp. 931-937.

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Official URL: http://edoc.unibas.ch/dok/A6003332

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Abstract

Free tissue transfer has been the gold standard of extensive skull base reconstruction, but the onlay of free flaps onto skull base defects carries the risk of cerebrospinal fluid (CSF) leakage. The purpose of this study was the evaluation of a novel technique of a combined sub- and onlay concept with a partially intracranially positioned folded free fasciocutaneous flap in terms of flap applicability, versatility and complication rate. Within 5 years, 7 patients with anterior (n=4), middle (n=2) or posterior (n=1) skull base defects were reconstructed with free extended lateral arm (n=3) or anterolateral thigh (n=4) flaps. The flaps were partially intracranially positioned and fixed with osteo-dermal sutures. Both flaps proved to be applicable in terms of sealing efficiency, minimizing intracranial flap volume and folding. No flap loss was observed. Specific complications consisted of one pneumocranium via an accessory frontal sinus and one cerebellar herniation due to lumbar CSF loss. No flap failure or haematoma of the intracranial flap part occurred. This new concept of intracranial positioning of fasciocutaneous flaps in a sandwich technique using osteo-dermal sutures should be considered as a primary treatment for skull base reconstruction rather than merely as a salvage manoeuvre.
Faculties and Departments:03 Faculty of Medicine > Bereich Operative Fächer (Klinik) > Bewegungsapparat und Integument > Plastische, rekonstruktive, ästhetische und Handchirurgie (Schaefer)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Operative Fächer (Klinik) > Bewegungsapparat und Integument > Plastische, rekonstruktive, ästhetische und Handchirurgie (Schaefer)
03 Faculty of Medicine > Bereich Operative Fächer (Klinik) > Kopfbereich > Kiefer- und Gesichtschirurgie (Zeilhofer)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Operative Fächer (Klinik) > Kopfbereich > Kiefer- und Gesichtschirurgie (Zeilhofer)
UniBasel Contributors:Schaefer, Dirk Johannes and Kunz, Christoph N. and Jaquiéry, Claude Armand and Haug, Martin Dieter
Item Type:Article, refereed
Article Subtype:Research Article
Bibsysno:Link to catalogue
Publisher:Churchill Livingstone
ISSN:0901-5027
Note:Publication type according to Uni Basel Research Database: Journal article
Identification Number:
Last Modified:27 Feb 2014 15:45
Deposited On:27 Feb 2014 15:45

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