Reconstruction of complex soft tissues defects of the cranial vault in neurooncological patients

Abstract

Objective. To improve the results of surgical treatment of neurooncological patients with complex defects of the soft tissues of the cranial vault using trapezius musculocutaneous flaps (TMF).Маterials and methods. During the period from September 2016 to March 2017, 3 patients with complex defects of the soft tissues of the cranial vault were observed after removal of large and giant advaced extra-intracranial malignant tumors. Reconstruction of complex soft tissue defects was performed using horizontal (2) and vertical (1) trapezius musculocutaneous flaps.Results. The location and direction of the dominant trapezius musculocutaneous vessels determines two possible variants of microvascular flaps formation: a horizontal flap with the inclusion of a horizontal muscle part on the basis of the superficial feeding branch of the transverse cervical artery and a vertical flap with the inclusion of a vertical part of the muscle on the basis of the deep feeding branch of the transverse cervical artery. The choice of reconstruction type depends on the defect anatomical location and the volume of necessary tissues.Conclusions. In patients with advanced stages of cranial carcinoma, the operation of choice for the plasty of complex defects in the soft tissues of the cranial vault is the use of regional trapezius musculoskeletal flaps. The type, shape and necessary volume of the tissues depends on the size and location of the complex defect. The use of a horizontal trapezius musculocutaneous flap is recommended for the plasty of the temporoparietal region of the head, and a vertical trapezoidal musculocutaneous flap should be used to close the occipital parietal defect.