title: The nasal floor pedicled flap: a novel technique for use in skull base reconstruction.
abstract: BACKGROUND
  Skull base reconstruction can be accomplished using various donor sites. Vascularized tissue, commonly the nasoseptal flap, is the most effective option for large defects or high flow leaks. In cases where the septum cannot be used, a mucoperiosteal flap from the nasal floor, pedicled from the sphenopalatine artery, is a viable option without reported outcomes. The aim of this work was to describe this flap and to report successful outcomes in a cohort of patients.
  
  
  METHODS
  Retrospective chart review of patients seen by the senior author from 2011 to 2013 requiring skull base reconstruction for defects with cerebrospinal fluid leak.
  
  
  RESULTS
  A total of 108 patients underwent endoscopic skull base reconstruction. Ten patients had reconstruction with use of a pedicled nasal floor flap. Mean age was 53.3 years. Defects involved the ethmoid roof in 5 patients, sellar floor in 2, clivus in 2, and planum sphenoidale in 1. Reasons why the septal flap could not be used were intentional sacrifice due to disease involvement, sacrifice for proper exposure, or previous septal perforation. Mean length of follow-up was 10.2 (range, 4 to 25) months. No patient developed cerebrospinal fluid leaks postoperatively.
  
  
  CONCLUSIONS
  Nasal floor pedicled flaps are an effective alternative to nasoseptal flaps for reconstruction of the skull base, and have not been previously described in the literature. Outcomes are promising in our small cohort of patients. If the septum must be sacrificed, attention should be paid to the nasal floor, which provides a large mucoperiosteal flap that can be consistently exposed and elevated by the experienced surgeon.
authors.affiliation: Emory University School of Medicine, Atlanta, GA.
authors.forename: Pedram
authors.initials: P
authors.lastname: Daraei
authors.forename: Nelson M
authors.initials: NM
authors.lastname: Oyesiku
authors.forename: Zara M
authors.initials: ZM
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D065634:Cerebrospinal Fluid Leak / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009300:Nasal Septum / Q000637:transplantation*; D059747:Nasal Surgical Procedures / Q000379:methods; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D013524:Surgical Flaps
keywords: cerebrospinal fluid leak; nasal floor; nasal reconstruction; pedicled flap; reconstructive techniques; skull base reconstruction; vascularized flap