52 4 226 234 2009 watertight watertight 53 5 temporal musculo pericranial flap frontal musculo pericranial flap 1984 5 5 60 1 2 3 2 8 38 226
52 4 1 2/3 1 2 3 50 905 912 2007 7 3 1 A B C 2 loose areolar tissue 1 8 1. A BC 10cm 10 12cm 1 loose areolar tissue 2 227 39
52 4 a b supraorbital bar 4 5 50 905 912 2007 7 3 supraorbital bar 4 2. 2 3 watertight 8 2/3 loose areolar tissue 5 loose areolar tissue loose areolar tissue 2 temporal line 2cm loose areolar tissue net work 40 228
52 4 7 6 5 9 2cm loose areolar tissue 3. pericranium 10 loose areolar tissue flap pericranium pericranial flap 10 11 80 7 12 pericranial flap 7 pericranium 6 12 6 watertight watertight 2/3 2 2cm 2 1 8 1. 2cm 5 4 7 229 41
52 4 a b 8 9 ABC supraorbital bar D EF 7 8 4 7 8 4 5 7 4 watertight 7 spinal drainage 2. 2/3 overlap flap 2/3 6 supraorbital bar 9supraorbital bar pedicle supraorbital bar overlap 42 230
52 4 10 A B C 9 3. supraorbital bar 9 supraorbital bar pedicle 10 1 3 10 20 bed up 20 bed up 1 watertight 3 4 3 4 1 1992 2 10 14 1. flap 80 15 20 2. 9 2 231 43
52 4 a b c d e f 11 a b 3D CTc CT d 3D CTe CT f watertight 2 28 1 25 4 1 1 2 4 26 le Fort I 11a b c 3 44 232
52 4 2 11d e f watertight 1 94 343 350 1991. 2 Kiyokawa K, Tai Y, Yanaga H, Inoue Y, Hayakawa K, et al A surgical method for treating anterior skull base injuries. Cranio Maxillofacial Surg 27 11 19, 1997. 3 1 37 207 213 1994. 4 Kiyokawa K, Tai Y, Inoue Y, Tanabe HY, Hayakawa K, et al Efficacy of temporal musculopericranial flap for reconstruction of the anterior base of skull. Scand J Plast Reconstr Hand Surg 34 43 53, 2000. 5 34 337 346 1991. 6 38 700 711 1992. 7 Kiyokawa K, Tai Y, Inoue Y, Yanaga H, Mori K, et al A reconstruction method using musculo pericranial flaps that prevents cerebrospinal fluid rhinorrhea and intracranial complications after extended anterior skull base. Skull Base Surg 9 211 219, 1999. 8 50 905 912 2007. 9 Nakajima H, Imanishi N, Minabe T The arterial anatomy of the temporal region and the vascular basis of various temporal flap. Br J Plast Surg 48 439 450, 1995. 10 Argenta LC, Friedman RJ, Dingman RO, Duus EC The versatility of pericranial flaps. Plast Reconstr Surg 76 695 702, 1985. 11 Price JC, Loury M, Carson B Johns ME The pericranial flap for reconstruction of anterior skull base defects. Laryngoscope 98 1159 1164, 1988. 12 Jackson IT, Adham MN, Marsh WR Use of the Galeal frontalis myofascial flap in craniofacial surgery. Plast Reconstr Surg 77 905 910, 1985. 13 Fukuta K, Potparic Z, Sugihara T, Rachmiel A, Forté RA, et al A cadaver investigation of the blood supply of the galeal frontalis flap. Plast Reconstr Surg 94 794 800, 1994. 14 1 38 523 527 1983. 15 Brisman R, Hughes JEO, Mount LA Cerebrospinal fluid rhinorrhoea. Arch Neurol 22 245 252, 1970. Summary STANDARDIZATION OF THE METHODS OF THE RECONSTRUCTION OF THE ANTERIOR SKULL BASE AND THE APPLICATION TO THE SKULL BASE INJURY Hideaki Rikimaru, PhD, MD Kensuke Kiyokawa, PhD, MD Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine In reconstruction of the anterior skull base, it is important to repair the dural defect to be a watertight, and to surely intercept between the cranial cavity and the nasal or para nasal cavity. The temporal musculo pericranial flap that is the local flap with the blood circulation is the most useful reconstructive material for the dural defect. In the interception between the cranial cavity and the nasal or para nasal cavity, the frontal musculo pericranial flap is used. The reconstructive methodbecamesafebyusingtheseflaps. Therefore,it 233 45
52 4 was standardized and adapted to the skull base injury in our institution. We performed this reconstructive method on 53 cases after the resection of the tumor of the anterior skull base and the skull base injury. The local infection was developed in 5 cases and they were all healed by debridement and irrigation. None of the patients developed severe complication including liquorrhea, meningitis, or brain abscess. This method using these local flap was very safe and effective. Key words reconstruction of the skullbase, temporal musculo pericranial flap, frontal musculo pericranial flap 46 234