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Background: A variety of revascularization techniques have been reported for the management of moyamoya disease to prevent risks of stroke. STA (superficial temporal artery)–MCA (middle cerebral artery) microanastomosis, single or double bypass, with temporal muscle or galeal onlay graft has been the standard operative procedure. Method: Our rationale of revascularization surgery has been a combination of STA-MCA double bypass using the frontal and the parietal branches of STA and transfer of a highly vascularized thick galeal flap with maintained STA vasculature. Conclusion: This STA-enhanced vascularized galeal flap graft is extremely effective for revascularization of moyamoya disease. [ABSTRACT FROM AUTHOR]

Hui-hsiu Chang,1,2 Edward Suh,3 Blake H Fortes,3 Franklin Zheng,3 Anny MS Cheng3,4 1Division of Plastic and Reconstructive Surgery, Department of Surgery, National Taiwan University Hosiptal Yunlin Branch, Yunlin, Taiwan; 2Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin, Taiwan; 3Department of Ophthalmology, Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA; 4Ocular Surface Center, Miami, FL, USA Purpose: To present a successful case of single-staged total upper eyelid reconstruction after sebaceous gland carcinoma excision by using forehead galeal pericranial flap.Observations: An 80-year-old female with a progressively enlarged left upper eyelid mass presented with ocular irritation, blurred vision, and gritty sensation despite topical antibiotics treatment. This multinodular mass involved the left total upper eyelid, compromised corneal surface integrity, and caused complete ptosis. Excisional biopsy confirmed advanced sebaceous gland carcinoma, which was followed by extensive excision. The resultant total upper eyelid defect was reconstructed by a forehead galeal pericranial flap accompanied by anterior and posterior lamellar grafts. For the 34-month follow-up period, patient remained symptom-free without tumor recurrence and achieved acceptable cosmetic outcome.Conclusion: The forehead galeal pericranial flap appears to be effective as single-staged total upper lid reconstruction following extensive sebaceous gland carcinoma excision to restore eyelid function, avoid corneal exposure, and achieve acceptable cosmesis. Keywords: forehead, galeal pericranial flap, reconstruction, sebaceous gland carcinoma, single-staged, total upper eyelid reconstruction

La causa más frecuente de una solución de continuidad de los huesos de la calota craneana es un traumatismo craneoencefálico grave. La reparación de la misma es lo que conocemos como craneoplastia. El objetivo de nuestro artículo es presentar nuestros primeros resultados de craneoplastia con tela de titanio y colgajo galeal bipediculado. A través de un estudio retrospectivo, descriptivo, tipo serie de casos, relatamos los resultados de nuestra experiencia en craneoplastia con tela de titanio y colgajo sobre 10 pacientes operados entre Enero y Octubre de 2007, tras valoración con Tomografía Computerizada, de los cuales el 90% fueron de sexo masculino y con una edad media de 29,9 años. El tiempo medio de internamiento hospitalario fue de 10,3 días. Tuvimos un caso de complicación y una reintervención por desplazamiento de la tela de titanio a los 4 meses. Todos los pacientes quedaron satisfechos con los resultados. Como conclusión, la craneoplastia con tela de titanio asociada a colgajo galeal bipediculado es un procedimiento eficaz y viable dentro de la red pública hospitalaria.A falta de continuidade entre ossos da calota craniana é mais frequentemente causada por trauma crânio-encefálico grave. A reparação dessas deformidades é conhecida como cranioplastia. Objetivo: Avaliar os resultados dos primeiros casos da cranioplastia com tela de titânio e retalho galeal bipediculado. Por meio de estudo retrospectivo, descritivo, tipo série de casos, relatam-se os resultados de cranioplastia com tela de titânio e retalho a que 10 pacientes foram submetidos, entre Janeiro a Outubro de 2007, após avaliação por tomografia computadorizada, sendo 90% do sexo masculino, com média de idade de 29,9 anos. O tempo médio de internamento foi de 10,3 dias. Houve uma complicação e uma reoperação por deslocamento da tela após quatro meses. Todos os pacientes ficaram satisfeitos com os resultados. Conclusão: A cranioplastia com tela de titânio associada ao retalho galeal bipediculado é um procedimento eficaz e viável na rede pública hospitalar.The discontinuity of skull cap bones is most frequently caused by severe crane-encephalic trauma. The repair of these deformities is known as cranioplasty. In our paper we evaluate first results of cranioplasty with titanium meshes and galeal bipediculated remnant, according to a retrospective, series of cases, one described the results of cranioplasty with titanium meshes and remnant involving 10 patients attempted from January to October 2007, after pre-surgery evaluation by computerized tomography. Ninety per cent of patients were males, with mean age equal to 29.9 years old. Mean internment time was equal to 10.3 days. There was one complication and one case of resurgery due to the blast of a mesh after four months. All patients were satisfied with surgical and esthetical results. As a conclusion, cranioplasty with titanium mesh associated to galeal bipediculated remnant if effective and viable at public hospital services.

Background: Failure of skull base reconstruction is a life-threatening issue. This study describes surgical techniques utilising various types of galeal flaps and reports on outcome of these procedures for skull base reconstruction. Method: Clinical records of 136 patients (75 men, 61 women; mean age, 50.0 years) who required skull base reconstruction with galeal flaps were reviewed retrospectively. Patients had undergone skull base surgeries with simultaneous reconstruction for benign tumours in 77 patients, malignant tumours in 53, and other lesions in 6. We repaired dural defects using a fascial patch, and covered the skull base defects using various types of galeal flap according to the size and location of the skull base defects. Routine spinal drainage was not used in any patients. Findings: Reconstruction was performed as planned in all patients. We utilised a galea frontalis flap in 17 patients, temporoparietal galeal flap in 95, temporoparietal galeal flap with calvarial bone in 9, and bipedicled temporoparietal galeal flap in 15. Postoperative complications included scalp wound necrosis in 8 patients (5.9%), transient leakage of cerebrospinal fluid in 3 (2.2%), and intracranial infection in 2 (1.5%). Necrosis of the galeal flaps was not encountered. Conclusions: Galea is a well-vascularised tissue with homogenous thickness. Since the galeal layer covers the entire head area, various types of galeal flap can be elevated to cover any size and location of skull base defect. [ABSTRACT FROM AUTHOR]

The discontinuity of skull cap bones is most frequently caused by severe crane-encephalic trauma. The repair of these deformities is known as cranioplasty. In our paper we evaluate first results of cranioplasty with titanium meshes and galeal bipediculated remnant, according to a retrospective, series of cases, one described the results of cranioplasty with titanium meshes and remnant involving 10 patients attempted from January to October 2007, after pre-surgery evaluation by computerized tomography. Ninety per cent of patients were males, with mean age equal to 29.9 years old. Mean internment time was equal to 10.3 days. There was one complication and one case of resurgery due to the blast of a mesh after four months. All patients were satisfied with surgical and esthetical results. As a conclusion, cranioplasty with titanium mesh associated to galeal bipediculated remnant if effective and viable at public hospital services. [ABSTRACT FROM AUTHOR]

Summary: Introduction: Upper lid reconstruction depends on the size of the defect, and a general consensus holds that partial-thickness defects can be reconstructed using simple or composite grafts. Full-thickness defects involving up to 30% of the upper lid are repaired easily by direct suturing with or without upper lid sliding flaps. When defects affect more than 50–70% of the upper lid, complex reconstruction is needed. Traditionally, this devolves upon lower lid flaps, as in the Cutler–Beard and Mustardé techniques. These methods share intrinsic disadvantages, such as donor site morbidity and the need for two surgical sessions to detach the flap pedicle. To our knowledge, upper lid reconstruction with a grafted forehead galeal–pericranial flap has not been previously reported. This proves to be an excellent reconstructive option for extensive upper lip defects. Moreover, it has many advantages over other reconstruction techniques, such as technical ease and very low donor site morbidity. Furthermore, it is a single-stage procedure. We present our experience with five extensive upper lid reconstructions using galeal–pericranial forehead grafted flaps. Materials and methods: Five patients needed major upper lid reconstruction, which consisted of a galeal–pericranial forehead flap grafted with oral mucosa and retroauricular skin. Four of them had had the lid removed surgically for oncological reasons, while one patient suffered from orbital–periorbital fasciitis. Results: All of the flaps and grafts survived. The functional and morphological results were satisfying, and no complications were noted. Conclusions: The forehead galeal–pericranial flap appears to be an excellent instrument for upper lid reconstruction. Compared to other techniques, it has the advantages of simplicity and very minimal donor site morbidity. Moreover, it does not necessitate a two-stage surgical procedure. [Copyright &y& Elsevier]

Large surgical defects of the scalp provide a challenge for the reconstructive surgeon due to the relative inelasticity of scalp skin and the lack of an adjacent tissue reservoir. Often they necessitate a repair utilizing a full- or partial-thickness skin graft. Not uncommonly, however, Mohs extirpation of more extensive or aggressive tumours may necessitate removal of periosteum resulting in exposure of bare bone, which is an avascular bed and may not support a skin graft placed directly upon it. The role of cortical bone fenestration in facilitating granulation of such defects to heal by secondary intention has recently been elegantly described by Barry et al. We discuss our techniques of utilizing galeal/periosteal flaps (GPFs) to resurface exposed bone, providing a vascular bed for a skin graft and allowing immediate reconstruction of large scalp defects. [ABSTRACT FROM AUTHOR]

Objective: Although sphenoidotomy is more commonly performed via the transnasal approach than via the transcranial approach, transcranial sphenoidotomy (TCS) remains indispensable for en bloc resection of locally advanced sinonasal malignant tumors (SNMTs) extending to the skull base. TCS also enables transsphenoidal transposition of the temporoparietal galeal flap (TPGF) to compensate for the lack of vascularized reconstructive tissue after endoscopic transnasal skull base surgery. The objective of this study was to review the authors' surgical experience using TCS with an emphasis on the surgical anatomy of the sphenoid sinus and on the purpose of TCS. Relevant anatomy is further illustrated through cadaveric dissection and photo documentation., Methods: The authors reviewed the records of 50 patients who underwent TCS at the Nagoya University Hospital, Fukushima Medical University Hospital, or Aichi Medical University Hospital over the course of 7 years (between January 2011 and November 2017). The authors also performed cadaveric dissection in 2 adult cadaveric skull base specimens., Results: Of the 50 patients included in this study, 44 underwent craniofacial resection (CFR) for en bloc resection of SNMTs involving the anterior and/or lateral skull base, and 6 underwent transsphenoidal transposition of the TPGF flap. The authors categorized the TCS procedures according to the portion of the sphenoid sinus wall involved (i.e., superior, lateral, and superolateral). Superior sphenoidotomy was used in patients requiring anterior CFR. Lateral sphenoidotomy was further divided into 2 subtypes, with type 1 procedures performed for the transsphenoidal transpositioning of the TPGF, and type 2 procedures used in patients requiring lateral CFR. Superolateral sphenoidotomy was used in anterolateral CFR., Conclusions: TCS still represents a useful tool in the armamentarium of neurosurgeons treating central skull base lesions. The newly proposed surgical classification facilitates a profound understanding of TCS and how to incorporate this technique into clinical practice.

The maxillary swing procedure provides an excellent approach to the anterior skull base region and to the clivus. The osteotomy should not be standard; it should vary with the size and position of the central skull base tumor being resected. The main reason for publishing this article is to draw attention to a method of preventing ascending infection from the oral cavity to the intracranial area using the palatal overlap flap. Examples of this approach are provided.