title: Surgical anatomy and utility of pedicled vascularized tissue flaps for multilayered repair of skull base defects.
abstract: OBJECT The objective of this study was to describe the surgical anatomy and technical nuances of various vascularized tissue flaps. METHODS The surgical anatomy of various tissue flaps and their vascular pedicles was studied in 5 colored silicone-injected anatomical specimens. Medical records were reviewed of 11 consecutive patients who underwent repair of extensive skull base defects with a combination of various vascularized flaps. RESULTS The supraorbital, supratrochlear, superficial temporal, greater auricular, and occipital arteries contribute to the vascular supply of the pericranium. The pericranial flap can be designed based on an axial blood supply. Laterally, various flaps are supplied by the deep or superficial temporal arteries. The nasoseptal flap is a vascular pedicled flap based on the nasoseptal artery. Patients with extensive skull base defects can undergo effective repair with dual flaps or triple flaps using these pedicled vascularized flaps. CONCLUSIONS Multiple pedicled flaps are available for reconstitution of the skull base. Knowledge of the surgical anatomy of these flaps is crucial for the skull base surgeon. These vascularized tissue flaps can be used effectively as single or combination flaps. Multilayered closure of cranial base defects with vascularized tissue can be used safely and may lead to excellent repair outcomes.
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Sam
authors.initials: S
authors.lastname: Safavi-Abbasi
authors.affiliation: Department of Neurological Surgery, University of Florida, Gainesville, Florida, and.
authors.forename: Noritaka
authors.initials: N
authors.lastname: Komune
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma.
authors.forename: Jacob B
authors.initials: JB
authors.lastname: Archer
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Hai
authors.initials: H
authors.lastname: Sun
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Theodore
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: James
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Little
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Peter
authors.initials: P
authors.lastname: Nakaji
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Sughrue
authors.affiliation: Department of Neurological Surgery, University of Florida, Gainesville, Florida, and.
authors.forename: Albert L
authors.initials: AL
authors.lastname: Rhoton
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Spetzler
mesh_terms: D000328:Adult; D002102:Cadaver; D006801:Humans; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D019291:Skull Base / Q000293:injuries* / Q000601:surgery*; D012887:Skull Fractures / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply*; D055815:Young Adult
keywords: NSF = nasoseptal flap; STA = superficial temporal artery; cerebrospinal fluid leak; skull base fractures; skull base reconstruction; surgical technique; temporoparietal fascia