Article

Vascularized Fascial Patch for Repair of Suboccipital Dural Defect

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Abstract

Advanced knowledge about cutaneous vascularity has enabled the development of axial flaps such as fasciocutaneous, septocutaneous, and musculocutaneous flaps. It has also laid the foundation for microsurgical free flaps. The newly emerging concept of angiosomes sheds yet more light on the complexity and multiplicity of peripheral blood supply. We describe the use of an extended vertical trapezius flap carrying a segment of latissimus dorsi muscle with the underlying paraspinal fascia to close an infected and irradiated posterior fossa craniectomy and dural defect. This flap illustrates the elevation of an angiosomal block of tissues as an axial flap vascularized by the alternative major blood supply of one of its constituents. The potentials of this "angiosomal flap" are explored. A brief review of dural defect repair is also presented.

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... There have been few reports on use of the trapezius flap with a segment of the LDM. In 1996, Atiyeh et al. 11 described using an extended vertical trapezius flap including a segment of the LDM with the underlying paraspinal fascia to close an infected suboccipital dural defect in one patient. Chen et al. 12 used an extended vertical LTMF with the LDM to reconstruct defects in the skull base in three patients. ...
Article
The pedicled lower trapezius musculocutaneous flap (LTMF) can extend far beyond the lateral border of the trapezius muscle, with a reliable blood supply. However, the distal part of the extended LTMF lacks a muscular component, limiting its usage in complex defect reconstruction, which often requires obliteration of dead space and coverage of vital structures. To overcome this limitation, we modified the LTMF by adding a segment of latissimus dorsi muscle (LDM). Between 2014 and 2021, the modified extended LTMF were used to reconstruct complex defects in the head, neck, shoulder, and contralateral chest wall and back in 19 patients. By preserving the interconnections between the branches of the posterior intercostal arteries, we were able to include various amounts of LDM within the extended LTMF. The LDM component was used to obliterate dead space and repair wounds involving cerebrospinal fluid leakage, infection, radioactive osteomyelitis, exposed carotid artery, lung, and implant materials. The average flap size was 30.7 ☓ 10.9 cm (range, 25 ☓ 8 cm to 40 ☓ 14 cm). The average size of the LDM was 113.9 cm² (range, 27.7–216.6 cm²). Partial flap necrosis occurred in two patients and the secondary defects were reconstructed using a local flap. The remaining 17 flaps survived completely. The LTMF carrying a segment of the LDM could be considered for patients undergoing reconstruction of complex defects in the head, neck, shoulder, and contralateral chest wall and back, and for patients who are ineligible for free flap reconstruction.
Article
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The syndrome of aseptic meningitis is characterized by spiking fever and meningismus. CSF analysis generally shows increased pleocytosis, hypoglycorrhachia, elevated protein and negative cultures. In an earlier series, 70% of children with posterior fossa operations developed the syndrome. In a new review the incidence was slightly more than 30%. The incidence of aseptic meningitis following operation for structural lesions was 44%, which was higher than the tumor group, where the meningitic syndrome was seen in 25% of the children. It is the purpose of this paper to reexamine the impact that steroids have made on the prevalence of the aseptic meningitis syndrome, and to review recent studies that have attempted to distinguish between aseptic and bacterial meningitis.
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