A Novel Graft Material for Preventing Cerebrospinal Fluid Leakage in Skull Base Reconstruction: Technical Note of Perifascial Areolar Tissue

Hayashi, Nakamasa; Mitsuya, Koichi; Gorai, Katsuya; Inoue, Keita; Ito, Ichiro; Nakagawa, Masahiro; Nakasu, Yoko

doi:10.1055/s-0034-1386655

Cited by 5 publications

(3 citation statements)

References 21 publications

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“…Since then, PAT grafting has been applied to cover tissue defects after head and neck cancer resections, dead space, cerebrospinal fluid leakage after brain tumor resection, and vascular leakage as a sealing device. 3 – 5 Nakajima et al 6 – 8 reported that the deep layer of the adipofascial system was formed by a mobile structure known as the lubricant adipofascial system, which is rich in blood vessels and mesenchymal stem cells. After PAT grafting on tissue defects, the vascular network in the PAT promotes vascularization to the wound bed.…”

Section: Discussionmentioning

confidence: 99%

Exposed Artificial Plate Covered With Perifascial Areolar Tissue as a Nonvascularized Graft

Ito

Akazawa

Ichikawa

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Summary:Perifascial areolar tissue (PAT) is a loose connective tissue on deep fascia, such as on the groin, thigh, or temporal region, which has abundant vascular plexus and mesenchymal stem cells. Nonvascularized PAT grafts can survive even on hypovascular wound beds. Therefore, PAT grafting is a possible alternative to conventional flap surgery to cover exposed bone or artifacts. In this article, we describe 2 cases of PAT grafting for the treatment of skin ulcers with exposed bone and artificial plate after mandible reconstruction. After negative-pressure wound therapy, PAT was used to covering exposed artificial plate for both cases, and a skin graft onto the PAT graft was performed in 1 case. The ulcers improved in both cases without recurrence. The gold-standard treatment of intractable ulcers and fistulas with an exposed tendon, bone, or artifact is coverage by a well-vascularized skin flap. However, PAT grafting has advantages in similar situations, occasionally together with skin grafting and/or negative-pressure wound therapy, because it is technically simple and less invasive.

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Section: Discussionmentioning

confidence: 99%

Exposed Artificial Plate Covered With Perifascial Areolar Tissue as a Nonvascularized Graft

Ito

Akazawa

Ichikawa

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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“…The most significant complication of CSF leakage is meningitis [4]. Without intervention, the risk of developing meningitis is estimated to be 10% annually and 40% in the long term [10]. Surgical intervention remains the panacea for managing iatrogenic CSF leakages [11].…”

Section: Discussionmentioning

confidence: 99%

Cerebrospinal Fluid Leakage During Temporal Bone Surgery: Selecting Intra-operative Dural Closure with a Dumbbell-Shaped Muscle Graft as a Surgical Approach

Yazdani

Khorsandi-Ashtiani

Tashakorinia

et al. 2017

Indian J Otolaryngol Head Neck Surg

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Cerebrospinal fluid (CSF) leakages of the temporal bone may arise during mastoid surgery. The leakages can have multiple potential etiologies, for instance, using a cutting burr near the bony tegmen or monopolar electrocautery on the surface of the dura mater. In this paper, we introduced an effective and simple technique for the management of CSF leakages of the temporal bone. In a prospective case series, 36 patients (16 males and 20 females) who have had an experience of incidental or inevitable CSF otorrhea or otorhinorrhea during temporal bone surgery were selected. All patients were treated using a muscle graft in a dumbbell-shaped design through the dura defect at the Amir-Alam University Hospital between April 2005 and November 2008. The mean size of the defects was 5 mm (a range of 2-10 mm). A dumbbell-shaped autologous muscle graft was immediately successful in sealing the leakage in all patients. Only five patients (13.8%) had some evidence of leakage remaining on the day after the operation, which was subsequently resolved by conservative management in four of them (11.1%). Only one patient (2.7%) was subjected to a second operation for a new defect. Recurrence of CSF leakage or other related complications were not observed during about 7 years of follow up. A free autologous muscle graft, using the dumbbell technique through a small to moderate dura defect is an effective, easily performed, and safe method to seal iatrogenic leakages of the temporal bone.

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“…Several clinical studies have reported the potential use of perifascial areolar tissue (PAT) grafts in the treatment of such wounds [1][2][3][4][5][6][7]. Additionally, PAT grafts have demonstrated versatility as reconstructive membranes in tympanoplasty [8,9] as well as for skull base or spinal dural reconstruction in cases of cerebrospinal fluid leakage [8][9][10]. Thus, PAT may serve as a high-quality graft tissue for wounds involving the exposed ischemic tissue and any membrane structure.…”

Section: Introductionmentioning

confidence: 99%

Perifascial areolar tissue graft promotes angiogenesis and wound healing in an exposed ischemic component rabbit model

Miyanaga,

Yoshitomi,

Miyanaga

2024

PLoS ONE

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Multiple studies have reported the use of perifascial areolar tissue (PAT) grafts to treat wounds involving exposed ischemic tissues, avascular structures, and defective membrane structures. Our objective was to assess the quantitative effects of PAT grafts and their suitability for wounds with ischemic tissue exposure and to qualitatively determine the factors through which PAT promotes wound healing and repair. We conducted histological, immunohistochemical, and mass spectrometric analyses of the PAT grafts. PAT grafts contain numerous CD34+ progenitor/stem cells, extracellular matrix, growth factors, and cytokines that promote wound healing and angiogenesis. Furthermore, we established a male rabbit model to compare the efficacy of PAT grafting with that of an occlusive dressing treatment (control) for wounds with cartilage exposure. PAT grafts could cover ischemic components with granulation tissue and promote angiogenesis. Macroscopic and histological observations of the PAT graft on postoperative day seven revealed capillaries bridging the ischemic tissue (vascular bridging). Additionally, the PAT graft suppressed wound contraction and alpha smooth muscle actin (αSMA) levels and promoted epithelialization. These findings suggested that PAT can serve as a platform to enhance wound healing and promote angiogenesis. This is the first study to quantify the therapeutic efficacy of PAT grafts, revealing their high value for the treatment of wounds involving exposed ischemic structures. The effectiveness of PAT grafts can be attributed to two primary factors: vascular bridging and the provision of three essential elements (progenitor/stem cells, extracellular matrix molecules, and growth factors/cytokines). Moreover, PAT grafts may be used as transplant materials to mitigate excessive wound contraction and the development of hypertrophic scarring.

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A Novel Graft Material for Preventing Cerebrospinal Fluid Leakage in Skull Base Reconstruction: Technical Note of Perifascial Areolar Tissue

Cited by 5 publications

References 21 publications

Exposed Artificial Plate Covered With Perifascial Areolar Tissue as a Nonvascularized Graft

Exposed Artificial Plate Covered With Perifascial Areolar Tissue as a Nonvascularized Graft

Cerebrospinal Fluid Leakage During Temporal Bone Surgery: Selecting Intra-operative Dural Closure with a Dumbbell-Shaped Muscle Graft as a Surgical Approach

Perifascial areolar tissue graft promotes angiogenesis and wound healing in an exposed ischemic component rabbit model

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