I P Tang1, R L Carrau1, B A Otto1, D M Prevedello2, P Kasemsiri1, L Ditzel2, J Muto2, B Kapucu1, C Kirsch3. 1. Department of Otolaryngology - Head and Neck Surgery,Wexner Medical Centre,Ohio State University,Columbus,Ohio,USA. 2. Department of Neurological Surgery,Wexner Medical Centre,Ohio State University,Columbus,Ohio,USA. 3. Department of Radiology,Wexner Medical Centre,Ohio State University,Columbus,Ohio,USA.
Abstract
BACKGROUND AND METHODS: Reconstruction with a vascularised flap provides the most reliable outcome, with post-operative cerebrospinal fluid leak rates of less than 5 per cent. This article aims to review and summarise the critical technical aspects of the vascularised flaps most commonly used for skull base reconstruction. RESULTS: Vascularised flaps are classified as intranasal or extranasal. The intranasal group includes the Hadad-Bassagaisteguy nasoseptal flap, the Caicedo reverse nasoseptal flap, the nasoseptal rescue flap, the posteriorly or anteriorly based lateral wall flaps, and the middle turbinate flap. Extranasal flaps include the transfrontal pericranial and transpterygoid temporoparietal flaps. CONCLUSION: The Hadad-Bassagaisteguy nasoseptal flap is overwhelmingly favoured for reconstructing extensive defects of anterior, middle and posterior cranial base. Its pertinent technical features are described. However, it is essential to master the skills required for the various extranasal or regional vascularised flaps because each can offer a reconstructive alternative for specific patients, especially when open approaches are needed and/or intranasal vascularised flaps are not feasible.
BACKGROUND AND METHODS: Reconstruction with a vascularised flap provides the most reliable outcome, with post-operative cerebrospinal fluid leak rates of less than 5 per cent. This article aims to review and summarise the critical technical aspects of the vascularised flaps most commonly used for skull base reconstruction. RESULTS: Vascularised flaps are classified as intranasal or extranasal. The intranasal group includes the Hadad-Bassagaisteguy nasoseptal flap, the Caicedo reverse nasoseptal flap, the nasoseptal rescue flap, the posteriorly or anteriorly based lateral wall flaps, and the middle turbinate flap. Extranasal flaps include the transfrontal pericranial and transpterygoid temporoparietal flaps. CONCLUSION: The Hadad-Bassagaisteguy nasoseptal flap is overwhelmingly favoured for reconstructing extensive defects of anterior, middle and posterior cranial base. Its pertinent technical features are described. However, it is essential to master the skills required for the various extranasal or regional vascularised flaps because each can offer a reconstructive alternative for specific patients, especially when open approaches are needed and/or intranasal vascularised flaps are not feasible.
Authors: Juan R Gras-Cabrerizo; Elena García-Garrigós; Joan R Montserrat-Gili; Juan R Gras-Albert; Rosa Mirapeix-Lucas; Humbert Massegur-Solench; Miquel Quer-Agusti Journal: Indian J Otolaryngol Head Neck Surg Date: 2017-09-06
Authors: Sercan Gode; Stefan Lieber; Ana Carolina Igami Nakassa; Eric W Wang; Juan C Fernandez-Miranda; Paul A Gardner; Carl H Snyderman Journal: J Neurol Surg B Skull Base Date: 2018-09-04