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DOI: 10.1055/s-0039-3402013
Skull Base Reconstruction with Multilayered Fascia Lata: A Single-Center 17 Years Experience
Abstract
Objective Reconstruction after open surgery of anterior skull base lesions is challenging. The fascia lata graft is our workhorse for achieving dural sealing and preventing cerebrospinal fluid leak and meningitis. This study seeks to analyze the donor and recipient site complication rates after fascia lata reconstruction.
Methods This is a retrospective review of all open anterior skull base operations in which a double-layer fascia lata graft was used for the reconstruction of the defect from 2000 to 2016 at the Tel-Aviv Sourasky Medical Center, a tertiary referral center in Israel.
Results Of the 369 patients operated for skull base lesions, 119 underwent open anterior skull base surgery and were reconstructed with a fascia lata graft. The patients' mean age was 47.1 years, and 68 (57.1%) were males. The overall postoperative early and late donor site complication rates were 6.7% (n = 8) and 5.9% (n = 7), respectively. Multivariate analysis found minor comorbidities and persistent/recurrent disease as being predictors for early-term complications. The overall postoperative early central nervous system (CNS) complication rate was 21.8% (n = 26), while 12.6% (n = 15) of the patients had late postoperative CNS complications.
Conclusion Reconstruction of open anterior skull base lesions with fascia lata grafting is a safe procedure with acceptable complication and donor site morbidity rates.
Publication History
Received: 09 May 2019
Accepted: 03 November 2019
Article published online:
08 January 2020
© 2020. Thieme. All rights reserved.
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References
- 1 Ono J, Takeda A, Akimoto M. et al. Free tensor fascia lata flap and synthetic mesh reconstruction for full-thickness chest wall defect. Case Rep Med 2013; 2013: 914716
- 2 Kageyama Y, Suzuki K, Matsushita K, Nogimura H, Kazui T. Pericardial closure using fascia lata in patients undergoing pneumonectomy with pericardiectomy. Ann Thorac Surg 1998; 66 (02) 586-587
- 3 Wasserman BN, Sprunger DT, Helveston EM. Comparison of materials used in frontalis suspension. Arch Ophthalmol 2001; 119 (05) 687-691
- 4 Gillies H. Experiences with fascia lata grafts in the operative treatment of facial paralysis: (section of otology and section of laryngology). Proc R Soc Med 1934; 27 (10) 1372-1382
- 5 Foley SJ, Adamson AS. Minimally invasive harvesting of fascia lata for use in the pubovaginal sling procedure. BJU Int 2001; 88 (03) 293-294
- 6 Stensbirk F, Thorborg K, Konradsen L, Jørgensen U, Hölmich P. Iliotibial band autograft versus bone-patella-tendon-bone autograft, a possible alternative for ACL reconstruction: a 15-year prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2014; 22 (09) 2094-2101
- 7 Friedrich JB, Hanel DP, Chilcote H, Katolik LI. Management of Posttraumatic Radioulnar Synostosis. J Am Acad Orthop Surg 2012; 20: 450-458
- 8 Amir A, Gur E, Gatot A, Zucker G, Cohen JT, Fliss DM. Fascia lata sheaths harvest revisited. Oper Tech Otolaryngol--Head Neck Surg 2000; 11 (04) 304-306
- 9 Amir A, Gatot A, Zucker G, Sagi A, Fliss DM. Harvesting large fascia lata sheaths: a rational approach. Skull Base Surg 2000; 10 (01) 29-34
- 10 Ganly I, Patel SG, Singh B. et al. Complications of craniofacial resection for malignant tumors of the skull base: report of an International Collaborative Study. Head Neck 2005; 27 (06) 445-451
- 11 Kraus DH, Shah JP, Arbit E, Galicich JH, Strong EW. Complications of craniofacial resection for tumors involving the anterior skull base. Head Neck 1994; 16 (04) 307-312
- 12 Gil Z, Abergel A, Leider-Trejo L. et al. A comprehensive algorithm for anterior skull base reconstruction after oncological resections. Skull Base 2007; 17 (01) 25-37
- 13 Ketcham AS, Hoye RC, Van Buren JM, Johnson RH, Smith RR. Complications of intracranial facial resection for tumors of the paranasal sinuses. Am J Surg 1966; 112 (04) 591-596
- 14 Kwon D, Iloreta A, Miles B, Inman J. Open anterior skull base reconstruction: a contemporary review. Semin Plast Surg 2017; 31 (04) 189-196
- 15 Klatt-Cromwell CN, Thorp BD, Del Signore AG, Ebert CS, Ewend MG, Zanation AM. Reconstruction of skull base defects. Otolaryngol Clin North Am 2016; 49 (01) 107-117
- 16 Gullane PJ, Lipa JE, Novak CB, Neligan PC. Reconstruction of skull base defects. Clin Plast Surg 2005; 32 (03) 391-399 , vii
- 17 Mattavelli D, Schreiber A, Ferrari M. et al. Three-layer reconstruction with iliotibial tract after endoscopic resection of sinonasal tumors. World Neurosurg 2017; 101: 486-492
- 18 Link MJ, Converse LD, Lanier WL. A new technique for single-person fascia lata harvest. Neurosurgery 2008; 63 (04, Suppl 2): 359-361
- 19 Naugle Jr TC, Fry CL, Sabatier RE, Elliott LF. High leg incision fascia lata harvesting. Ophthalmology 1997; 104 (09) 1480-1488
- 20 Tay VS-L, Tan KS, Loh ICY. Minimally invasive fascia lata harvest: a new method. Plast Reconstr Surg Glob Open 2013; 1 (01) 1-2
- 21 Mattavelli D, Schreiber A, Villaret AB. et al. Complications and donor site morbidity of 3-layer reconstruction with iliotibial tract of the anterior skull base: retrospective analysis of 186 patients. Head Neck 2018; 40 (01) 63-69
- 22 Wheatcroft SM, Vardy SJ, Tyers AG. Complications of fascia lata harvesting for ptosis surgery. Br J Ophthalmol 1997; 81 (07) 581-583
- 23 Vitali M, Canevari FR, Cattalani A, Grasso V, Somma T, Barbanera A. Direct fascia lata reconstruction to reduce donor site morbidity in endoscopic endonasal extended surgery: a pilot study. Clin Neurol Neurosurg 2016; 144 (144) 59-63
- 24 Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol 1994; 47 (11) 1245-1251
- 25 Fliss DM, Gil Z, Spektor S. et al. Skull base reconstruction after anterior subcranial tumor resection. Neurosurg Focus 2002; 12 (05) e10
- 26 Chibber PJ, Shah HN, Jain P. A minimally invasive technique for harvesting autologous fascia lata for pubo-vaginal sling suspension. Int Urol Nephrol 2005; 37 (01) 43-46
- 27 Ringel B, Carmel-Neiderman NN, Peri A. et al. Continuous lumbar drainage and the postoperative complication rate of open anterior skull base surgery. Laryngoscope 2018; 128 (12) 2702-2706