title: Complications associated with the pedicled nasoseptal flap for skull base reconstruction.
abstract: OBJECTIVE
  To analyze complications associated with nasoseptal flap elevation and reconstruction in endoscopic skull base surgery.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Retrospective chart review of all patients who underwent nasoseptal flap procedure in our institution between 2008 and 2013.
  
  
  RESULTS
  A total of 121 patients were identified with a mean follow-up time of 10.4 months. Complications associated with this procedure occurred in 33 patients (27%). The majority of complications were related to the septal donor site and included septal perforation, cartilage necrosis, and prolonged crusting. Other complications included intraoperative injury to the flap pedicle (n = 4) or recurrent/persistent cerebrospinal fluid leak occurring in the early postoperative period (n = 7). Long-term quality-of-life data assessed via Sinonasal Outcome Test-22 questionnaires did not reveal notable differences when compared to preoperative scores.
  
  
  CONCLUSIONS
  The complication rate associated with nasoseptal flap elevation and inset is higher than previously described. The majority of complications became manifest beyond the immediate postoperative period and were associated with the septal donor site, including septal perforation, prolonged crusting, and cartilage necrosis. We hypothesize that donor site morbidity may be related to compromise of the contralateral septal vascular supply during the procedure. The range and frequency of complications of nasal septal flap surgery should be considered in counseling patients who may receive a nasoseptal flap for skull base reconstruction.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.
authors.forename: Ethan
authors.initials: E
authors.lastname: Soudry
authors.forename: Alkis J
authors.initials: AJ
authors.lastname: Psaltis
authors.forename: Kun H
authors.initials: KH
authors.lastname: Lee
authors.forename: Reza
authors.initials: R
authors.lastname: Vaezafshar
authors.forename: Jayakar V
authors.initials: JV
authors.lastname: Nayak
authors.forename: Peter H
authors.initials: PH
authors.lastname: Hwang
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004724:Endoscopy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D055171:Nasal Cartilages / Q000473:pathology; D061270:Nasal Septal Perforation / Q000209:etiology; D009336:Necrosis; D009668:Nose Diseases / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D013524:Surgical Flaps / Q000009:adverse effects* / Q000601:surgery*; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods; D060053:Transplant Donor Site / Q000473:pathology; D055815:Young Adult
keywords: Nasoseptal flap; complications; endoscopic skull base surgery; pedicle; septal flap; skull base reconstruction