title: Evolution of a paradigm for free tissue transfer reconstruction of lateral temporal bone defects.
abstract: BACKGROUND
  Tumors of the lateral skull base are best treated with surgery plus or minus radiation therapy. Surgical ablation may involve cutaneous structures, the auricle, the parotid, and the lateral temporal bone. These composite soft tissue defects are best reconstructed with composite tissue. Multiple pedicled flaps have been used to reconstruct these defects. Free flaps have been shown to provide the best tissue for these reconstructions. We review our experience and present an algorithm for their reconstruction.
  
  
  METHODS
  A case series of consecutive patients treated between 1999 and 2006 at 2 tertiary care institutions, Oregon Health and Science University and University of Alabama at Birmingham were reviewed. There were 73 patients who had periauricular defects requiring 74 free tissue transfers in this retrospective chart review. All defects had extensive cutaneous loss and underwent some form of parotidectomy. There were 57 lateral temporal bone defects and 16 periauricular defects where the external auditory canal was preserved. The majority of patients had nonmelanoma skin malignancies (65%). Eighty percent of patients had undergone previous treatment (radiation therapy, surgery, or a combination therof).
  
  
  RESULTS
  Early on, reconstruction was performed using a radial forearm (RFFF, n=29), evolving to lateral arm (n=6), rectus (n=11), and finally an anterolateral thigh (ALT, n=28) free flap. The average hospital stay was 6 days, and the overall complication rate was 22%. The rectus flap needed debulking in 34% of patients, and the anterolateral thigh in 9%. Periauricular defects were classified based on preservation of the external auditory canal (class I), lateral temporal bone resection with preservation of the auricle (class II), or lateral temporal bone with total auriculectomy (class III).
  
  
  CONCLUSIONS
  Class I defects were best managed by RFFF reconstruction, class II defects were managed well with the ALT flap, and class III defects required the ALT or rectus flap.
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Eben L
authors.initials: EL
authors.lastname: Rosenthal
authors.forename: Teresa
authors.initials: T
authors.lastname: King
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: McGrew
authors.forename: William
authors.initials: W
authors.lastname: Carroll
authors.forename: J Scott
authors.initials: JS
authors.lastname: Magnuson
authors.forename: Mark K
authors.initials: MK
authors.lastname: Wax
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D004424:Ear Canal / Q000601:surgery; D004432:Ear, Middle / Q000601:surgery; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008416:Mastoid / Q000601:surgery; D008875:Middle Aged; D037981:Neck Dissection; D010306:Parotid Gland / Q000601:surgery; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012468:Salivary Gland Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D012878:Skin Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D019291:Skull Base / Q000601:surgery; D013524:Surgical Flaps; D013701:Temporal Bone / Q000601:surgery*