title: Free tissue transfer for skull base reconstruction analysis of complications and a classification scheme for defining skull base defects.
abstract: OBJECTIVE
  The role of free flaps in skull base reconstruction is discussed in detail. Twenty-six microvascular free tissue transfers performed in 22 patients are reviewed in detail. A classification scheme for skull base defects is presented.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Twenty-two patients with neoplasms that involve the skull base underwent a combined craniotomy and facial approach for resection. The resultant defects were reconstructed with a variety of microvascular free flaps.
  
  
  RESULTS
  All 22 patients were ultimately successfully reconstructed with a free flap. One patient required a second free flap following ablative surgery for a recurrent tumor. The initial free flaps in three patients were unsuccessful and a second flap was required. The classification scheme was applied to all defects.
  
  
  CONCLUSIONS
  The creation of a functional separation of the intracranial and extracranial cavities can be extremely difficult to accomplish, especially when multiple cavities (nasal, oral, pharyngeal) are violated. Free flaps provide a solution to this problem in select cases. Skull base defects can and should be classified for the purpose of communication, treatment planning, prognosis of reconstruction, and judging therapeutic outcome.
authors: Department of Otolaryngology, Mount Sinai School of Medicine, New York, NY 10029, USA.
authors: M L
authors: ML
authors: Urken
authors: P J
authors: PJ
authors: Catalano
authors: C
authors: C
authors: Sen
authors: K
authors: K
authors: Post
authors: N
authors: N
authors: Futran
authors: H F
authors: HF
authors: Biller
mesh_terms: D000328:Adult; D000368:Aged; D001847:Bone Diseases / Q000145:classification* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies; D019291:Skull Base / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps / Q000009:adverse effects*; D016896:Treatment Outcome