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Temporal Galeofascial Flap for Reconstruction After Transmaxillary Approaches to the Clival Region.

颞骨瓣用于经上颌入路斜坡区后的重建。

  • 影响因子:1.52
  • DOI:10.1016/j.wneu.2019.09.038
  • 作者列表:"Gagliardi F","Boari N","Piloni M","Bailo M","Caputy AJ","Mortini P
  • 发表时间:2020-02-01
Abstract

BACKGROUND:A paramount concern after transmaxillary approaches has been skull base reconstruction. Regional pedicled flaps represent the best reconstructive option. We have described a technique to harvest a lateral-based multilayered vascularized flap for skull base reconstruction after resection of large tumors using the transmaxillary transpterygoid approach (TMTPA). METHODS:We performed a cadaver study using the TMTPA to harvest the combined temporal galeofascial flap (CTGF). The first layer, with major sealing capabilities, is composed by a temporoparietal galeal-pericranial flap. The second layer is composed by temporal muscle fascia to provide mechanical support for flap dural engrafting. RESULTS:The CTGF provides excellent coverage of both the clival dural lining and the ipsilateral pterygopalatine fossa structures (×1.6). The CTGF is pliable and easy to harvest. It offers great flexibility in flap content and design, providing a large quantity of vascularized tissue. The vascular pedicle derives from the superficial temporal vessels, which can ensure flap trophism. CONCLUSIONS:CTGF represents an effective option as a regional multilayered pedicled flap for skull base reconstruction after resection of clival tumors using the TMTPA. The flap pedicle, owing to its anatomical location, will often be preserved even after repeated microsurgical or endoscopic procedures, providing a technical alternative for reconstruction even in patients who have undergone multiple surgeries with low residual availability of regional flaps.

摘要

背景: 经上颌入路后最关注的问题是颅底重建。区域带蒂皮瓣代表了最佳的重建选择。我们已经描述了一种技术,在使用经上颌移位入路 (TMTPA) 切除大肿瘤后收获基于侧方的多层血管蒂皮瓣进行颅底重建。 方法: 我们用ttpa进行尸体研究,收获联合颞侧筋膜瓣 (CTGF)。第一层,具有主要的封闭能力,由颞顶骨-颅周皮瓣组成。第二层由颞肌筋膜组成,为皮瓣硬脑膜包裹提供机械支持。 结果: CTGF对斜坡硬膜衬里和同侧翼腭窝结构均有良好的覆盖 (× 1.6)。CTGF柔韧,易于收获。它在皮瓣内容和设计方面提供了很大的灵活性,提供了大量的血管化组织。血管蒂来源于颞浅血管,可保证皮瓣滋养。 结论: CTGF是使用TMTPA切除斜坡肿瘤后颅底重建的区域多层带蒂皮瓣的有效选择。皮瓣蒂,由于其解剖位置,即使经过反复的显微外科或内窥镜手术,也往往会被保留下来,即使在接受过多次手术且区域皮瓣残余可用性低的患者中,也为重建提供了技术替代方案。

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DOI:10.1259/bjr.20180883
作者列表:["Tran S","Puric E","Walser M","Poel R","Datta NR","Heuberger J","Pica A","Marder D","Lomax N","Bolsi A","Morach P","Bachtiary B","Seddon BM","Schneider R","Bodis S","Weber DC"]

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影响因子:1.41
发表时间:2020-03-01
DOI:10.1177/1078155219842277
作者列表:["Gyori DJ","Bullington SM","Crawford BS","Vernon VP"]

METHODS:BACKGROUND:National guidelines recommend screening and treatment for cancer-related bone disease and continued monitoring of bone-modifying agents. It is unclear whether a standardized screening tool is utilized to identify eligible patients and ensure appropriate supportive care is implemented. The purpose of this study was to evaluate current prescribing practices and optimize management of bone-modifying agents. METHODS:A retrospective chart review was performed to identify patients who received hormone deprivation therapy or had bone metastases through Hematology/Oncology or Urology clinics from 1 November 2016 to 31 October 2017. The primary endpoints of this study were the incidence of completed baseline dual-energy X-ray absorptiometry (DEXA) scan for patients on hormone deprivation therapy and percent of patients started on a bone-modifying agent for the prevention of skeletal-related events secondary to bone metastasis. Secondary endpoints included percent of patients with dental examinations prior to initiation, adequate calcium and vitamin D supplementation, incidence of osteonecrosis of the jaw or flu-like symptoms and education, and percent of bisphosphonate doses appropriately adjusted based on renal function. RESULTS:A total of 375 patients were assessed for baseline DEXA scans and bone-modifying therapy. Of the 226 patients on hormone deprivation therapy, 111 (49%) patients were appropriately screened with a DEXA scan prior to initiation of hormone deprivation therapy. Among the 149 patients with bone metastases, only 94 (63.1%) patients were started on a bone-modifying agent. CONCLUSIONS:Opportunities have been identified to optimize management of patients with cancer-related bone disease. Implementation of standardized tools may increase the rate of appropriate screening and initiation of bone-modifying therapy when warranted.

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影响因子:2.83
发表时间:2020-01-01
DOI:10.1007/s00520-019-04843-9
作者列表:["Dohzono S","Sasaoka R","Takamatsu K","Hoshino M","Nakamura H"]

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骨肿瘤方向

骨肿瘤是发生于骨骼或其附属组织的肿瘤。有良性,恶性之分,良性骨肿瘤易根治,预后良好,恶性骨肿瘤发展迅速,预后不佳,死亡率高。

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