“In situ bone flap” combined with vascular pedicled mucous flap to reconstruction of skull base defect

BACKGROUND At present,neuroendoscopy technology has made rapid development,and great progress has been made in the operation of lesions in the saddle area of the skull base.However,the complications of cerebrospinal fluid and intracranial infection after the operation are still important and life-threatening complications,which may lead to poor prognosis.AIM To investigate the method of in situ bone flap combined with nasal septum mucosal flap for reconstruction of enlarged skull base defect by endonasal sphenoidal approach and to discuss its application effect.METHODS Clinical data of 24 patients undergoing transnasal sphenoidal endoscopic approach in the Department of Neurosurgery,Affiliated 2 Hospital of Nantong University from January 2019 to December 2022 were retrospectively analyzed.All patients underwent multi-layer reconstruction of skull base using in situ bone flap combined with nasal septum mucosa flap.The incidence of intraoperative and postoperative cerebrospinal fluid leakage and intracranial infection were analyzed,and the application effect and technical key points of in situ bone flap combined with nasal septum mucosa flap for skull base bone reconstruction were analyzed.RESULTS There were 5 cases of high flow cerebrospinal fluid(CSF)leakage and 7 cases of low flow CSF leakage.Postoperative cerebrospinal fluid leakage occurred in 2 patients(8.3%)and intracranial infection in 2 patients(8.3%),which were cured after strict bed rest,continuous drainage of lumbar cistern combined with antibiotic treatment,and no secondary surgical repair was required.The patients were followed up for 8 to 36 months after the operation,and no delayed cerebrospinal fluid leakage or intracranial infection occurred during the follow-up.Computed tomography reconstruction of skull base showed satisfactory reconstruction after surgery.CONCLUSION The use of in situ bone flap combined with vascular pedicled mucous flap to reconstruction of skull base defect after endonasal sphenoidal approach under neuroendoscopy has a lower incidence of cerebrospinal fluid leakage and lower complications,which has certain advantages and is worthy of clinical promotion.

Double J Fixation after Craniotomy: Technical Description of a Modification Method for Bone Flap Fixation (Hiederov Method)

Background: Fixation of bone flap following craniotomy is usually achieved by synthetic materials. In rural and poor funding areas, innovation for cheap, safe and applicable material is needed. Purpose: The aim is to assess our new innovative technique in bone flap fixation against traditional techniques. Patients and Methods: The study was a prospective randomized controlled study enrolled at Al-Amal Hospital and Al-Ahly Bank Hospital from 2014-2019. Forty-eight patients were randomized in the study. Group A (24 patients) underwent titanium miniplate fixation while group B (24 patients) underwent our new technique. The new technique is double J tunnels performed by craniotome on either side of the bone (flap and skull sides), then a Prolene suture is passed through the shared stem of J’ holes and secured in the wrapped side of J’s holes and tying it tightly. Both techniques were examined against fixation time, rigidity, offset and final judgment postoperatively. Result: There was no statistically significant difference in using both techniques as regard fixation time. Our new technique was not inferior to the traditional one in achieving rigidity (p > 0.05). The final postoperative assessment was as equal as that seen in miniplate fixation. Conclusion: This technique is a simple, easy, cheap and effective method of fixing craniotomy bone flap.

The evolution of lower extremity reconstruction

Reconstruction of the lower extremity is a complex task that has evolved greatly in both technique and indication over the past century.Early advances in treating traumatic lower extremity injuries focused on primary amputation to avoid the high mortality of infection.The introduction of antibiotics improved surgical debridement and local reconstructive options,enhancing the viability of lower extremities with simple and proximal defects.With the advent of microvascular surgery,free tissue transfer techniques provided a means to reconstruct more distal and complex problems.As these surgical techniques have continued to evolve,so too have indications for reconstruction,patient management and post-operative care-now with a greater emphasis on patient quality of life and limb function.The purpose of this article is to outline the evolution of lower extremity reconstruction,and how the standard of practice has changed over time.