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Vol. 34. Issue 1.
Pages 22-31 (January - February 2023)
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Vol. 34. Issue 1.
Pages 22-31 (January - February 2023)
Clinical Research
Microsurgical free flaps for skull base reconstruction following tumor resection: Available techniques and complications
Utilización de colgajos libres microvasculares para la reconstrucción de la base del cráneo secundaria a resecciones tumorales: técnicas disponibles y complicaciones
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Pedro Ploua,
Corresponding author
, Luis Boccalatteb, Fernando Padilla-Lichtenbergera, Marcelo Figarib, Pablo Ajlera, Juan Larrañagab,c
a Department of Neurosurgery, Hospital Italiano de Buenos Aires, Argentina
b Section of Head and Neck Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Argentina
c Section of Reconstructive Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Argentina
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Abstract
Introduction

Resection of malignant tumors located in the anterior and middle fossae of the skull base requires thorough anatomical knowledge, as well as experience regarding the possible reconstructive options to resolve the resulting defects. The anatomical and functional relevance of the region, the complexity of the defects requiring reconstruction and the potential complications that can occur, represent a true challenge for the surgical team. The goal of this study is to describe the microsurgical reconstructive techniques available, their usefulness and postoperative complications, in patients with malignant tumors involving the skull base.

Materials and method

This observational, retrospective study, included all patients who underwent surgery for malignant craniofacial tumors from January 1st, 2009 to January 1st, 2019 at a University Hospital in Argentina. Only patients who required reconstruction of the resulting defect with a free flap were included.

Results

Twenty-four patients required reconstruction with FF; 14 were male (58.3%) and mean age was 54.9 years. Sarcoma was the most frequent tumor histology. Free flaps used were the following: anterolateral thigh, rectus abdominis, radial, latissimus dorsi, iliac crest and fibular. Complications occurred in 6 cases and no deaths were reported in the study group.

Conclusion

Free flaps are considered one of the preferable choices of treatment for large skull base defects. In spite of the complexity of the technique and the learning curve required, free flaps have shown to be safe, with a low rate of serious complications. For these patients, the surgical resolution should be performed by a multidisciplinary team.

Keywords:
Skull base reconstruction
Skull base surgery
Free flap
Malignant tumors
Resumen
Introducción

La resección de los tumores malignos de la base de cráneo anterior y media requieren no solo un amplio conocimiento anatómico, sino también experiencia en las posibles opciones reconstructivas factibles para resolver el defecto generado. La importancia anatómica y funcional de la región, la complejidad de los defectos a reconstruir y las posibles complicaciones que pueden desarrollar representan un verdadero desafío para el equipo quirúrgico. El objetivo del presente trabajo es exponer las posibles opciones reconstructivas microquirúrgicas, su utilidad y las complicaciones postoperatorias en pacientes con tumores malignos que comprometen la base de cráneo.

Materiales y método

Se realizó un estudio observacional retrospectivo de todos los pacientes operados de tumores malignos craneofaciales en el período comprendido entre el primero de enero de 2009 al primero de enero de 2019 en un hospital universitario de Argentina. Se incluyeron solo aquellos pacientes en los que fue necesario reconstruir el defecto a través de un colgajo libre (CL).

Resultados

Veinticuatro pacientes requirieron reconstrucción con CL. Catorce fueron varones (n=14 [58,3%]) y la media de edad fue de 54,9 años. La variedad tumoral histológica más frecuente fue el sarcoma. Los tipos de CL utilizados fueron los siguientes: anterolateral de muslo, recto anterior del abdomen, radial, dorsal ancho, cresta iliaca y fibular fueron los CL utilizados. Se reportó una tasa global de complicaciones del n=6 (25%). Un solo paciente presentó isquemia del colgajo. No hubo mortalidad asociada.

Conclusión

Los CL representan una de las primeras opciones en el tratamiento en defectos grandes de la base de cráneo. A pesar de la complejidad de la técnica y la curva de aprendizaje necesaria, los CL han demostrado ser seguros con bajas tasas de complicaciones graves. La resolución quirúrgica de estos pacientes se debe realizar por un equipo multidisciplinario.

Palabras clave:
Reconstrucción de la base del cráneo
Cirugía de la base del cráneo
Colgajo libre
Tumores malignos

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