title: Skull base reconstruction: an updated approach.
abstract: BACKGROUND
  The authors' goal was to develop an updated and comprehensive algorithm for skull base reconstruction based on data from the 10-year period following their initial report.
  
  
  METHODS
  Reconstructive outcomes were analyzed from 250 patients undergoing skull base reconstruction from 2000 to 2009.
  
  
  RESULTS
  Thirty-nine local or regional pedicled flap reconstructions and 211 free flap reconstructions were performed. Free flaps were usually selected over pedicled flaps for patients with a history of prior surgery, irradiation, or chemotherapy (p = 0.003, p < 0.001, and p = 0.04, respectively). Reconstructions were performed for 36 region I defects, 39 region II defects, 124 region III defects, and 51 defects involving more than one region. Complications occurred in 29.6 percent of patients. There were no significant differences in the overall complication rates between pedicled and free flap reconstructions (p = 0.70). The recipient-site complication rate decreased from 31 percent in the authors' prior report to 18.4 percent. A facial nerve repair was performed in 30 patients. By 12 months, 75 percent of patients had signs of reinnervation. Recovery was not significantly less likely in patients with preoperative weakness, postoperative irradiation, or age 60 years or older (p = 1.00, p = 1.00, and p = 0.11, respectively).
  
  
  CONCLUSIONS
  Based on the largest series of skull base reconstructions to date, the authors recommend pedicled flaps for limited defects because of minimal donor-site morbidity and shorter operative times and hospital stays. For extensive defects and cases involving prior surgery, irradiation, or chemotherapy, free flaps are preferred. Facial nerve repair should be attempted whenever feasible, even in the setting of preoperative weakness, anticipated postoperative irradiation, or advanced age.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Houston, Texas From the Departments of Plastic Surgery, Head and Neck Surgery, and Neurosurgery, University of Texas M. D. Anderson Cancer Center.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Hanasono
authors.forename: Amanda
authors.initials: A
authors.lastname: Silva
authors.forename: Roman J
authors.initials: RJ
authors.lastname: Skoracki
authors.forename: Paul W
authors.initials: PW
authors.lastname: Gidley
authors.forename: Franco
authors.initials: F
authors.lastname: DeMonte
authors.forename: Ehab Y
authors.initials: EY
authors.lastname: Hanna
authors.forename: David W
authors.initials: DW
authors.lastname: Chang
authors.forename: Peirong
authors.initials: P
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D005154:Facial Nerve / Q000601:surgery; D020220:Facial Nerve Injuries / Q000601:surgery; D005260:Female; D058752:Free Tissue Flaps; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009416:Nerve Regeneration / Q000502:physiology; D011183:Postoperative Complications / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D019291:Skull Base / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000601:surgery*; D013524:Surgical Flaps