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J Reconstr Microsurg 2003; 19(8): 561-566
DOI: 10.1055/s-2004-815643
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Secure Flap Fixation to Bony Tissue Using an Anchoring System in Skull-Base Surgery

Hideo Iida1 , Seiji Kishimoto2 , Tadashi Umeda1 , Yuiro Hata1
  • 1Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, Tokyo, Japan
  • 2Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Publication History

Publication Date:
14 January 2004 (online)

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ABSTRACT

The reconstruction of extensive skull-base defects using flap transfer decreases crucial postoperative complications. However, flap fixation to bony tissue is often difficult, especially if there is no soft tissue to pass sutures through, and unsteady flap fixation causes dead space formation or displacement of the transferred flap due to gravity. The authors used an anchoring system for secure flap fixation in seven cases with difficult flap fixation, using the conventional suturing technique. Anchors were inserted at strategic points in the bony tissue, and secure flap fixation was achieved in all cases. Postoperative CT scans showed no dead space formation, and major postoperative complications were not observed.

The anchoring system can be buried in bony tissue with a thickness of more than 4 mm, and it enables reliable flap fixation and dead space obliteration. Although the cost is relatively high, the procedure is simple and lowers the risk of crucial postoperative complications in skull-base surgery.

KEYWORDS

Anchoring system - flap fixation - skull-base reconstruction

REFERENCES

  • 1 Neligan P C, Mulholland S, Irish J. et al . Flap selection in cranial base reconstruction.  Plast Reconstr Surg . 1996;  98 1159-1166
    Search in Google Scholar
  • 2 Califano J C, Cordeiro P G, Disa J J. et al . Anterior cranial base reconstruction using free tissue transfer.  Head Neck . 2003;  25 89-96
    CrossrefPubMedSearch in Google Scholar
  • 3 Chang D W, Langstein H N, Gupta A. et al . Reconstructive management of cranial base defects after tumor ablation.  Plast Reconstr Surg . 2001;  107 1346-1355
    Search in Google Scholar
  • 4 Teknos T N, Smith J C, James T A. et al . Microvascular free tissue transfer in reconstructing skull base defects: lessons learned.  Laryngoscope . 2002;  112 1871-1876
    Search in Google Scholar
  • 5 Donald P J. Complications in skull base surgery for malignancy.  Laryngoscope . 1999;  109 1959-1966
    CrossrefPubMedSearch in Google Scholar
  • 6 Beals S P, Joganic E F, Holcombe T C. et al . Secondary craniofacial problems following skull base surgery.  Clin Plast Surg . 1997;  24 565-581
    PubMedSearch in Google Scholar
  • 7 Catalano P J, Hecht C S, Biller H F. et al . Craniofacial resection. An analysis of 73 cases.  Arch Otolaryngol Head Neck Surg . 1994;  120 1203-1208
    PubMedSearch in Google Scholar
  • 8 Nibu K, Sasaki T, Kawahara N. et al . Complications of craniofacial surgery for tumors involving the anterior cranial base.  Neurosurgery . 1998;  42 455-462
    CrossrefPubMedSearch in Google Scholar
  • 9 Urken M L, Catalano P J, Sen C. et al . Free tissue transfer for skull base reconstruction. Analysis of complications and a classification scheme for defining skull base defects.  Arch Otolaryngol Head Neck Surg . 1993;  119 1318-1325
    Search in Google Scholar
  • 10 Hall C R, Gabe C J, Laforset L. et al .Surgical localizers. Technical aspects of surgical localizer systems. In: Janeka IP, Tiedeman K, eds. Skull Base Surgery. Anatomy, Biology and Technology Philadelphia, NY: Lippincott-Raven Publishers 1996: 331-346
    Search in Google Scholar