Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-27T10:05:12.581Z Has data issue: false hasContentIssue false
  • English
  • Français

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]
Get access Rights & Permissions [Opens in a new window]

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 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Kassam, AB, Carrau, RL, Snyderman, CH, Gardner, P, Mintz, A. Evolution of reconstructive techniques following endoscopic expanded endonasal approach. Neurosurg Focus 2005;19:E8CrossRefGoogle Scholar
2Hadad, G, Bassagaisteguy, L, Carrau, RL, Mataza, JC, Kassam, A, Synderman, CH et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006;116:1882–6CrossRefGoogle ScholarPubMed
3Kassam, AB, Thomas, A, Carrau, RL, Snyderman, CH, Vescan, A, Prevedello, D et al. Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 2008;63(1Suppl 1):ONS44–52Google ScholarPubMed
4Rivero-Serrano, CM, Snyderman, CH, Gardner, P, Prevedello, D, Wheless, S, Kassam, AB et al. Nasoseptal ‘rescue’ flap: a novel modification of the nasoseptal flap technique for pituitary surgery. Laryngoscope 2011;121:990–3CrossRefGoogle Scholar
5Caicedo-Granados, E, Carrau, RL, Snyderman, CH, Prevedello, D, Fernandez-Miranda, J, Gardner, P et al. Reverse rotation flap for reconstruction of donor site after vascular pedicled nasoseptal flap in skull base surgery. Laryngoscope 2010;120:1550–2CrossRefGoogle ScholarPubMed
6Kasemsiri, P, Carrau, RL, Otto, BA, Tang, IP, Prevedello, DM, Muto, J et al. Reconstruction of the pedicled nasoseptal flap donor site with a contralateral reverse rotation flap: technical modifications and outcomes. Laryngoscope 2013;123:2601–4CrossRefGoogle ScholarPubMed
7Hadad, G, Rivero-Serrano, CM, Bassagaisteguy, LH, Carrau, RL, Fernandez-Miranda, J, Prevedello, DM et al. Anterior pedicle lateral nasal wall flap: a novel technique for the reconstruction of anterior skull base defects. Laryngoscope 2011;121:1606–10CrossRefGoogle ScholarPubMed
8Rivera-Serrano, CM, Bassagisteguy, LH, Hadad, G, Carrau, RL, Kelly, D, Prevedello, DM et al. Posterior pedicle lateral nasal wall flap: new reconstructive technique for large defects of the skull base. Am J Rhinol Allergy 2011;25:e212–6CrossRefGoogle ScholarPubMed
9Prevedello, DM, Barges-Coll, J, Fernandez-Miranda, JC, Morera, V, Jacobson, D, Madhok, R et al. Middle turbinate flap for skull base reconstruction: cadaveric feasibility study. Laryngoscope 2009;119:2094–8CrossRefGoogle ScholarPubMed
10David, SK, Cheney, SL. An anatomy study of the temporoparietal fascial flap. Arch Otolaryngol Head Neck Surg 1995;121:1153–6CrossRefGoogle ScholarPubMed
11Fortes, FS, Carrau, RL, Snyderman, CH, Kassam, A, Prevedello, D, Vescan, A et al. Transpterygoid transposition of a temporoparietal fascia flap: a new method for skull base reconstruction after endoscopic expanded endonasal approaches. Laryngoscope 2007;117:970–6CrossRefGoogle ScholarPubMed
12Yoshioka, N, Rhoton, AL Jr.Vascular anatomy of the anteriorly based pericranial flap. Neurosurgery 2005;57(1Suppl):11–16Google ScholarPubMed
13Price, JC, Loury, M, Carson, B, Johns, ME. The pericranial flap for reconstruction of anterior skull base defects. Laryngoscope 1988;98:1159–64CrossRefGoogle ScholarPubMed
14Smith, JE, Ducic, Y. The versatile extended pericranial flap for closure of skull base defects. Otolaryngol Head Neck Surg 2004;130:704–11CrossRefGoogle ScholarPubMed
15Cappabianca, P, Cavallo, LM, Esposito, F, Valente, V, de Divitiis, E. Sellar repair in endoscopic endonasal transsphenoidal surgery: Results of 170 cases. Neurosurgery 2002;51:1365–71CrossRefGoogle ScholarPubMed
16Seiler, RW, Mariani, L. Sellar reconstruction with resorbable vicryl patches, gelatin foam, and fibrin glue in transsphenoidal surgery: A 10-year experience with 376 patients. J Neurosurg 2000;93:762–5CrossRefGoogle ScholarPubMed
17Snyderman, CH, Janecka, IP, Sekhar, LN, Sen, CN, Eibling, DE. Anterior cranial base reconstruction: role of galeal and pericranial flaps. Laryngoscope 1990;100:607–14CrossRefGoogle ScholarPubMed