Comparative evaluation of bioplastic properties of fat and fascial autografts used for reconstruction of skull base dural defects

   INTRODUCTION. The water-tight closure of dural defects in the skull base is challenging and still unsolved. Fascial or fat grafts are most often used in skull base reconstruction. However, the sealing characteristics and the healing patterns of these grafts remain unexplored.

   AIM. Comparative assessment of the sealing and bioplastic features of the fat and fascial grafts.

   MATERIALS AND METHODS. The experiment was performed on 50 rabbits. The animals were divided into 4 groups. In groups 1st and 2nd, reconstruction of the dural defect was performed with a fat graft. In group 1^st, the graft was covered from above with a skin-muscle flap, in group 2^nd, it was isolated with a polytetrafluoroethylene plate to prevent the growth of scar tissue. In groups 3^rd and 4th, fascia was used. In group 3^rd, the fascia was covered with a skin-muscle flap, in group 4^th, the fascia was isolated. After 3, 7 and 14 days, after euthanasia, the tightness and strength of the reconstruction were examined by introducing colored liquid into the cranial cavity. The strength corresponded to the manometer value at which the liquid flowed out of the edges of the wound. At the second stage, a histomorphological examination was performed.

   RESULTS. During the study of the strength of the reconstruction, a statistically significant difference was obtained between the 1^st and 3^rd (p < 0.001) and the 2^nd and 4^th groups (p < 0.001) in favor of fat graft, especially in the early stages after surgery (after 3 and 7 days). Isolation of fascial graft from skin-muscle flap after 14 days significantly reduced the strength of the scar compared to the 3rd group ((200 ± 12.2) versus (242 ± 16.8) mm Hg (р < 0,05)). Histological examination after 7 days revealed intergrowth of the fat graft with the defect edges and vascularisation. After 14 days, complete integration into the defect occurred in the form of a “plastic plug”. The absence of an overlying vascularized flap had little effect on the integration process. For fascial graft was typical the complete fusion with the defect edges at 14 days after surgery. Isolation the fascia from the overlying tissues delayed reparative processes.

   CONCLUSION. Unlike fascia, the fat graft provides the greatest tightness and strength already in the early postoperative period. After 7 days, vascularization of the fat graft begins. The optimal time for fascial graft healing is 14 days after surgery. The absence of an overlying skin-muscle flap has little effect on the reparative processes of the fat graft, unlike the fascia, which requires mandatory closure with a vascularized flap.

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