Radial forearm free tissue transfer reduces complications in salvage skull base surgery.
OBJECTIVE
Patients who undergo skull base resection after prior surgery or radiation may be at high risk for complications when local flaps alone are used for reconstruction. To determine whether the complication rate could be reduced, fasciocutaneous free tissue transfer was used to reinforce the dural closure in patients who had prior skull base surgery or radiation.


METHODS
This study is a case series of 20 patients (14 males, 6 females, aged 8-79 years of age with a mean of 47.7 years) from 1997 to 2001 who had prior skull base surgery or radiation, and underwent salvage skull base resection without large volume defects. All patients had a radial forearm free tissue transfer to reinforce the dural closure. Six patients had an osseous component to the forearm flap to provide vascularized bone to the orbital rim.


RESULTS
The overall local complication rate was 35%. Three patients (15%) had major complications including 1 case of meningitis, 1 case of cerebrospinal fluid leak, and 1 case of a flap requiring venous salvage. There were no flap failures, 1 idiopathic median nerve palsy, and no pathologic radius bone fractures.


CONCLUSIONS
Reconstruction with fasciocutaneous free tissue transfer for high-risk patients with low-volume dural defects following skull base resection can minimize the risk of major postoperative complications.


METHODS
C.
Chepeha
Douglas B
DB
Department of Otolaryngology--Head and Neck Surgery, University of Michigan Health System, Ann Arbor 48109-0312, USA. dchepeha@umich.edu
Wang
Steven J
SJ
Marentette
Lawrence J
LJ
Thompson
Byron G
BG
Prince
Mark E
ME
Teknos
Theodoros N
TN
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005542:Forearm; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000601:surgery*; D011878:Radiotherapy / Q000009:adverse effects; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome