title: Vascularised local and free flaps in anterior skull base reconstruction.
abstract: Lesions of the anterior skull base often require sufficient closure in order to prevent cerebrospinal fluid (CSF) leak, ascending infection and/or brain tissue prolapse. The transfer of devitalized autologous, allogenic or xenogeneic material is not always sufficient particularly not in larger defects or in the recurrent situation. Here the transfer of vascularised tissue seems to be more appropriate. The anterior skull base with various complex defects of 41 patients was reconstructed in an interdisciplinary setting by vascularised, autologous tissue transfer. Minor defects (<2.5 cm in max. diameter), generally occurring after extended endoscopic skull base approaches (n = 26, among those meningiomas, recurrent CSF fistulas, chordoma, chondroblastoma, metastasis, nasal fistula), were reconstructed by a local, vascularized pedicled mucosal flap of the lower turbinate (n = 3) or septum (n = 23). Patients with major defects (>2.5 cm in max. diameter, n = 15), comprising those with malignoma, meningoencephalocele, aneurysmatic bone cyst and trauma, were repaired by a "sandwich technique" with a combination of calvarian split and galea periosteum flap in 10 patients, in one case with a temporalis muscle flap, while in 4 further patients free vascularised radial forearm flaps were used for revision after multiple unsuccessful operations elsewhere. After a mean follow-up time of 30.5 months 38 of the 41 cases were successfully repaired with respect to prevention and treatment of CSF leakage or brain tissue prolapse, only 3 cases needed surgical revision. The reconstruction of the anterior skull base bearing complex lesions is feasible using vascularised, autologous local and also distal tissue transfer in a close interdisciplinary cooperation.
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany. thomas.hoffmann@uk-essen.de
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Hoffmann
authors.forename: Nicolai
authors.initials: N
authors.lastname: El Hindy
authors.forename: Oliver M
authors.initials: OM
authors.lastname: Müller
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Schuler
authors.forename: Christoph
authors.initials: C
authors.lastname: Bergmann
authors.forename: Robert
authors.initials: R
authors.lastname: Hierner
authors.forename: Götz
authors.initials: G
authors.lastname: Lehnerdt
authors.forename: Stefan
authors.initials: S
authors.lastname: Mattheis
authors.forename: Martin
authors.initials: M
authors.lastname: Wagenmann
authors.forename: Jörg
authors.initials: J
authors.lastname: Schipper
authors.forename: Ulrich
authors.initials: U
authors.lastname: Sure
authors.forename: Stephan
authors.initials: S
authors.lastname: Lang
authors.forename: Daniel
authors.initials: D
authors.lastname: Hänggi
authors.forename: I Erol
authors.initials: IE
authors.lastname: Sandalcioglu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult