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Technical nuances of commonly used vascularised flaps for skull base reconstruction

Published online by Cambridge University Press:  13 July 2015

I P Tang ,
R L Carrau ,
B A Otto ,
D M Prevedello ,
P Kasemsiri ,
L Ditzel ,
J Muto ,
B Kapucu  and
C Kirsch
I P Tang*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Wexner Medical Centre, Ohio State University, Columbus, Ohio, USA Department of Otorhinolaryngology – Head and Neck Surgery, Faculty of Medicine at the University Malaysia Sarawak, Malaysia
R L Carrau
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Wexner Medical Centre, Ohio State University, Columbus, Ohio, USA
B A Otto
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Wexner Medical Centre, Ohio State University, Columbus, Ohio, USA
D M Prevedello
Affiliation:
Department of Neurological Surgery, Wexner Medical Centre, Ohio State University, Columbus, Ohio, USA
P Kasemsiri
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Wexner Medical Centre, Ohio State University, Columbus, Ohio, USA
L Ditzel
Affiliation:
Department of Neurological Surgery, Wexner Medical Centre, Ohio State University, Columbus, Ohio, USA
J Muto
Affiliation:
Department of Neurological Surgery, Wexner Medical Centre, Ohio State University, Columbus, Ohio, USA
B Kapucu
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Wexner Medical Centre, Ohio State University, Columbus, Ohio, USA
C Kirsch
Affiliation:
Department of Radiology, Wexner Medical Centre, Ohio State University, Columbus, Ohio, USA
*
Address for correspondence: Dr I P Tang, Department of Otolaryngology – Head & Neck Surgery, Wexner Medical Centre, Ohio State University, Room B221 Starling Loving Hall, 320 West 10th Avenue, Columbus, Ohio 43210, USA E-mail: [email protected]
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Abstract

Background and Methods:

Reconstruction with a vascularised flap provides the most reliable outcome, with post-operative cerebrospinal fluid leak rates of less than 5 per cent. This article aims to review and summarise the critical technical aspects of the vascularised flaps most commonly used for skull base reconstruction.

Results:

Vascularised flaps are classified as intranasal or extranasal. The intranasal group includes the Hadad–Bassagaisteguy nasoseptal flap, the Caicedo reverse nasoseptal flap, the nasoseptal rescue flap, the posteriorly or anteriorly based lateral wall flaps, and the middle turbinate flap. Extranasal flaps include the transfrontal pericranial and transpterygoid temporoparietal flaps.

Conclusion:

The Hadad–Bassagaisteguy nasoseptal flap is overwhelmingly favoured for reconstructing extensive defects of anterior, middle and posterior cranial base. Its pertinent technical features are described. However, it is essential to master the skills required for the various extranasal or regional vascularised flaps because each can offer a reconstructive alternative for specific patients, especially when open approaches are needed and/or intranasal vascularised flaps are not feasible.

Keywords

Skull BaseReconstructive Surgical ProceduresSurgical FlapsPedicled Flaps
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 129 , Issue 8 , August 2015 , pp. 752 - 761
Copyright
Copyright © JLO (1984) Limited 2015 

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