Free tissue transfer for skull base reconstruction analysis of complications and a classification scheme for defining skull base defects.
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.
Urken
M L
ML
Department of Otolaryngology, Mount Sinai School of Medicine, New York, NY 10029, USA.
Catalano
P J
PJ
Sen
C
C
Post
K
K
Futran
N
N
Biller
H F
HF
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