title: The posterior pedicle inferior turbinate flap: a new vascularized flap for skull base reconstruction.
abstract: BACKGROUND
  Expanded endonasal approaches (EEA) for the resection of lesions of the anterior and ventral skull base can create large defects with a significant risk of postoperative cerebrospinal fluid (CSF) leaks or exposure of the internal carotid artery. In these cases, a reconstruction using a vascularized flap facilitates rapid and complete healing of the defect. The Hadad-Bassagasteguy flap (HBF), a posterior pedicle nasoseptal flap, is our preferred reconstructive option; however, a prior posterior septectomy or prior wide sphenoidotomies preclude its use. We have developed two additional pedicled flaps to reconstruct these selected patients: the transpterygoid temporoparietal fascia flap, which is suitable for large defects, and the posterior pedicle inferior turbinate flap (PPITF), the subject of this paper.
  
  
  METHODS
  We developed a flap comprising the inferior turbinate mucoperiosteum pedicled on the inferior turbinate artery, a terminal branch of the posterior lateral nasal artery, which arises from the sphenopalatine artery. We retrospectively reviewed the clinical data of four patients who underwent a skull base reconstruction using a PPITF.
  
  
  RESULTS
  Four patients underwent a reconstruction with the PPITF after undergoing an EEA that produced a skull base defect associated with a CSF fistula (n = 2), an exposed internal carotid artery (n = 1), or a basilar aneurysm clip (n = 1). All patients had undergone posterior septectomies as part of previous EEAs. All flaps healed uneventfully and covered the entire defect.
  
  
  CONCLUSIONS
  The PPITF is a viable reconstructive option for patients with skull base defects of a limited size defect and in whom the HBF is not available.
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Minimally Invasive endoNeurosurgery Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Felipe S G
authors.initials: FS
authors.lastname: Fortes
authors.forename: Ricardo L
authors.initials: RL
authors.lastname: Carrau
authors.forename: Carl H
authors.initials: CH
authors.lastname: Snyderman
authors.forename: Daniel
authors.initials: D
authors.lastname: Prevedello
authors.forename: Allan
authors.initials: A
authors.lastname: Vescan
authors.forename: Arlan
authors.initials: A
authors.lastname: Mintz
authors.forename: Paul
authors.initials: P
authors.lastname: Gardner
authors.forename: Amin B
authors.initials: AB
authors.lastname: Kassam
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000150:complications* / Q000601:surgery; D013353:Subdural Effusion / Q000209:etiology / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome