Repair and Reconstruction of Cranial and Maxillofacial Defects

Abstract

In the early 1960s, when the combined craniomaxillofacial resection was carried out for the defects in the skull base and craniomaxillofacial area left after the combined craniomaxillofacial resection, such as exposure or defects of the dura mater, the researchers represented by Ketcham et al. [1, 2] (1963, 1966) adopted the method of direct closure and suture or free skin graft transplantation. The survival rate after free skin graft transplantation is low, and the cerebrospinal fluid leakage easily occurs. The severe cases can lead to intracranial infection and even be life-threatening. According to the report of Ketcham et al. [2] (1966), after repair of dura mater defect with free skin graft transplantation, both the incidence and mortality rates of the cerebrospinal fluid leakage are high. Whereafter, the adjacent local tissue flaps such as forehead flap, temporal muscle flap, and a variety of skull flaps are used to repair a variety of cranial base defects. Although the success rate of repair of skull base or craniomaxillofacial defects with the adjacent local tissue flaps is high, only small- and medium-sized defects can be repaired because of limited tissue volume [3]. For example, the total forehead flap was used to reconstruct the skull base defect in 13 patients in our department. Although the skull base defects had been repaired well, multiple patients had concurrent skull osteomyelitis due to necrosis of skin graft or partial skin flap after the new wound resulting from transfer of forehead flap was repaired with free skin graft or scalp flap. Moreover, the repair effect of reconstruction of middle skull base defect with the forehead flap was not good, and it was difficult to completely cover the defect [4]. In the 1970s, the regional tissue flaps such as pedicled pectoralis major myocutaneous flap, latissimus dorsi myocutaneous flap, and trapezius myocutaneous flap were used to repair large skull base or craniofacial defects, but due to restriction of the location of the pedicle, it was often difficult to completely transfer the regional tissue flap to cover the skull base defect; thus repair effect was not satisfactory [5, 6].