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John K. Houten, Gila R. Weinstein, Michael J. Collins, and Daniel Komlos

risk of wound complications in patients who previously had or postoperatively need radiation therapy. 8 , 11 , 12 Specialized wound closure techniques, particularly muscle flap mobilization, serve to reduce tension at the wound edges and increase the bulk of vascularized tissue in the midline and have been successfully employed as salvage maneuvers to manage wound complications. 13 , 14 There has been recent interest in investigating whether such techniques have a prophylactic role in subgroups of patients who are known to be at increased risk for wound

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Gabriel C. Tender, Scott Kutz, Deepak Awasthi, and Peter Rigby

herniation and CSF fistula. The two main approaches used are the transmastoid and the middle fossa ones. We developed a modified middle fossa approach together with a vascularized temporalis muscle flap as a barrier between the dural and bone defects ( Fig. 1 lower ). Fig. 1. Upper: Illustration depicting an encephalocele impinging on the ossicles. Lower: Illustration depicting an encephalocele repair with hydroxyapatite and a vascularized temporalis muscle flap. Clinical Material and Methods Patient Population We retrospectively reviewed 15

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Anne Morice, Frédéric Kolb, Arnaud Picard, Natacha Kadlub, and Stéphanie Puget

often caused by infection (up to 31.8%). 30 The high rate of local infection after CP may be explained by the instability of soft tissue coverage. The most common risk factors are under-tension closure, scar retraction, and soft tissue laceration modifying skin vascularization. All of these factors increase the risk of implant exposure. We present herein a 1-stage reconstructive technique using a porous hydroxyapatite (HA) implant and a free latissimus dorsi muscle flap in an 11-year-old patient after craniectomy secondary to a severe traumatic cranial vault injury

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John Litvak, Thomas C. Sumners, James L. Barron, and Larry S. Fisher

constrictor muscle is ready for insertion into the clival-atlas defect (dotted lines). Lower Right: The muscle flap fills the bone-dural defect with V-plasty mucosal closure. Following this retraction, the superior pharyngeal musculature, including the longus capitis, rectus capitis anterior, and longus coli was retracted laterally with an articulated Weitlaner retractor. The anterior atlanto-occipital ligament and membrane were incised in the midline, and elevated laterally. The anterior rim of the foramen magnum was identified using the C-arm image intensifier

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muscle flap to create a barrier between the repaired dural and bone defects. Fifteen consecutive cases of CSF fistulas treated at the authors' institution were retrospectively reviewed. All patients presented with otorrhea. Eleven patients had previously undergone ear surgery. A middle fossa approach was followed in all cases. The authors used a thin but watertight and vascularly preserved temporalis muscle flap that had been dissected from the medial side of the temporalis muscle and was laid intracranially on the floor of the middle fossa, between the repaired dura

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Lee Onn Chieng, Zachary Hubbard, Christopher J. Salgado, Allan D. Levi, and Harvey Chim

previous radiation therapy, chemotherapy, or previous failed surgeries and may also be indicated for patients with comorbidities such as diabetes who are at increased risk of infection. In the presence of a significant amount of dead space, a muscle flap may be useful for filling the space and decreasing the risk of seroma, hematoma, and surgical site infection. The therapeutic use of flaps for the coverage of complex spinal wounds is also widely practiced, particularly in the presence of exposed hardware. The majority of the available literature on this subject consists

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Katsumi Matsumoto, Katsuhito Akagi, Makoto Abekura, Motohisa Ohkawa, Osamu Tasaki, and Takahiro Tomishima

P terional craniotomy in which an interfascial temporal muscle flap is used provides excellent exposure for the treatment of parasellar tumors, aneurysms of the circle of Willis and upper basilar artery, and tumors or arteriovenous malformations in the anterior temporal lobe. 18 However, the interfascial pterional craniotomy requires dissection between the bone and the temporal muscle and between the temporal fascia and the skin, which can result in temporal muscle atrophy and paralysis of the frontotemporal branch of the facial nerve. 5, 12 In addition

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Elias Dakwar, Juan S. Uribe, Tapan A. Padhya, and Fernando L. Vale

inferior edge of the cervical hardware. Operation and Postoperative Course The patient underwent surgery for removal of the anterior hardware, and primary repair of the esophageal perforation with a SCM muscle flap. The surgery was performed by a neurosurgeon and an otolaryngological surgeon. Intraoperatively, the screws were found to still have good solid fixation and the anterior plate was not loose. Since the patient had evidence of fusion, no further stabilization was deemed necessary. The esophageal perforation healed and he did not require any further

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Laligam N. Sekhar, Victor L. Schramm Jr., and Neil F. Jones

enable the further anteroinferior reflection of the temporalis muscle and a flatter approach to the skull base. The mandibular condyle and the capsule of the temporomandibular joint are dislocated anteroinferiorly after dividing the attachment of the stylomandibular and sphenomandibular ligaments to the mandible. However, if more space is needed or if free muscle flap reconstruction is utilized, the condyle of the mandible is excised. Fig. 1. Diagrams showing the subtemporal-preauricular infratemporal approach to lateral and posterior cranial base neoplasms

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Stephen J. Hentschel, Laurence D. Rhines, Franklin C. Wong, Ziya L. Gokaslan, and Ian E. McCutcheon

kinetics of tracer clearance. The technique for an intercostal muscle flap has been described previously, but will be reiterated briefly. 2 The intercostal artery and vein are divided distally, and subperiosteal dissection is performed to remove the muscle from the inferior aspect of the superior rib and the superior aspect of the inferior rib, thus freeing a vascularized muscle pedicle all the way dorsally to the vertebral body. This pedicle of muscle can then be sutured to the duramater, covering the dural defect. Fibrin glue may also be used to assist in sealing