title: Plastic reconstructive surgery techniques for defect coverage of extended skull base defects.
abstract: OBJECTIVE
  Large skull base defects are extremely difficult to treat and have a severe impact on patients' physical appearance and functional aspects. These extensive defect zones are mainly caused by trauma, surgical interventions, or wide tumor excision. High-level microsurgical techniques are necessary to provide sufficient treatment. The aim of this study is to describe successful reconstructive strategies for surgical treatment.
  
  
  METHODS
  Nine patients with skull base defects were treated in our department from 2008 to 2014 (n = 9). Plastic surgical reconstruction was performed with latissimus dorsi (LD;) (n = 4), LD-scapula flaps (n = 2), vertical rectus abdominis myocutaneous (VRAM) flaps (n = 2), and a greater omentum flap (n = 1). The mean follow-up period was 2.3 ± 2.2 years (0.5-4.5 years). Oncologic diseases (8 patients) and iatrogenic damage (1 patient) caused the massive skull base defects.
  
  
  RESULTS
  In all cases, we achieved the final surgical treatment of large skull base defects by free flaps with permanent wound closure. The mean operating time was 5:53 h (range 4:45-7:52 h). The primary outcome measures were survival and sufficient defect coverage. Flap survival rate was 100%, and none of the patients deceased during the follow-up period. Furthermore, we demonstrated the surgical key points of LD-scapula flap closure in detail.
  
  
  CONCLUSIONS
  Plastic surgical defect coverage by well-perfused tissue flaps of large skull base defects provides an efficient and effective treatment option. Complex skin, soft tissue, and dural defects can be successfully covered with these preformed free flaps. The choice of flap is based on the individual case.
authors.affiliation: Department of Plastic, Aesthetic and Reconstructive Surgery, Hand Surgery, AGAPLESION Diakonieklinikum Rotenburg, Elise-Averdieck-Straße 17, 27356 Rotenburg (Wümme), Germany.
authors.forename: Felix J
authors.initials: FJ
authors.lastname: Paprottka
authors.affiliation: Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neubergstraße 1, 30625 Hannover, Germany.
authors.forename: Nicco
authors.initials: N
authors.lastname: Krezdorn
authors.affiliation: Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neubergstraße 1, 30625 Hannover, Germany.
authors.forename: Ramin
authors.initials: R
authors.lastname: Ipaktchi
authors.affiliation: Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neubergstraße 1, 30625 Hannover, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Radtke
authors.affiliation: Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neubergstraße 1, 30625 Hannover, Germany. Electronic address: Vogt.Peter@mh-hannover.de.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Vogt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D019291:Skull Base / Q000000981:diagnostic imaging / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult
keywords: AV loop; Aesthetic reconstruction; Cerebrospinal fluid leakage; Flap coverage; Plastic reconstruction; Skull base defects