Skip to main content Accessibility help
×
Home

Technical nuances of commonly used vascularised flaps for skull base reconstruction

  • I P Tang (a1) (a2), R L Carrau (a1), B A Otto (a1), D M Prevedello (a3), P Kasemsiri (a1), L Ditzel (a3), J Muto (a3), B Kapucu (a1) and C Kirsch (a4)...

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.

Copyright

Corresponding author

Address for correspondence: Dr I P Tang, Department of Otolaryngology – Head & Neck Surgery, Wexner Medical Centre, Ohio State University, Room B221 Starling Loving Hall, 320 West 10th Avenue, Columbus, Ohio 43210, USA E-mail: ingptang@yahoo.com

References

Hide All
1Kassam, AB, Carrau, RL, Snyderman, CH, Gardner, P, Mintz, A. Evolution of reconstructive techniques following endoscopic expanded endonasal approach. Neurosurg Focus 2005;19:E8
2Hadad, G, Bassagaisteguy, L, Carrau, RL, Mataza, JC, Kassam, A, Synderman, CH et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006;116:1882–6
3Kassam, AB, Thomas, A, Carrau, RL, Snyderman, CH, Vescan, A, Prevedello, D et al. Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 2008;63(1Suppl 1):ONS4452
4Rivero-Serrano, CM, Snyderman, CH, Gardner, P, Prevedello, D, Wheless, S, Kassam, AB et al. Nasoseptal ‘rescue’ flap: a novel modification of the nasoseptal flap technique for pituitary surgery. Laryngoscope 2011;121:990–3
5Caicedo-Granados, E, Carrau, RL, Snyderman, CH, Prevedello, D, Fernandez-Miranda, J, Gardner, P et al. Reverse rotation flap for reconstruction of donor site after vascular pedicled nasoseptal flap in skull base surgery. Laryngoscope 2010;120:1550–2
6Kasemsiri, P, Carrau, RL, Otto, BA, Tang, IP, Prevedello, DM, Muto, J et al. Reconstruction of the pedicled nasoseptal flap donor site with a contralateral reverse rotation flap: technical modifications and outcomes. Laryngoscope 2013;123:2601–4
7Hadad, G, Rivero-Serrano, CM, Bassagaisteguy, LH, Carrau, RL, Fernandez-Miranda, J, Prevedello, DM et al. Anterior pedicle lateral nasal wall flap: a novel technique for the reconstruction of anterior skull base defects. Laryngoscope 2011;121:1606–10
8Rivera-Serrano, CM, Bassagisteguy, LH, Hadad, G, Carrau, RL, Kelly, D, Prevedello, DM et al. Posterior pedicle lateral nasal wall flap: new reconstructive technique for large defects of the skull base. Am J Rhinol Allergy 2011;25:e2126
9Prevedello, DM, Barges-Coll, J, Fernandez-Miranda, JC, Morera, V, Jacobson, D, Madhok, R et al. Middle turbinate flap for skull base reconstruction: cadaveric feasibility study. Laryngoscope 2009;119:2094–8
10David, SK, Cheney, SL. An anatomy study of the temporoparietal fascial flap. Arch Otolaryngol Head Neck Surg 1995;121:1153–6
11Fortes, FS, Carrau, RL, Snyderman, CH, Kassam, A, Prevedello, D, Vescan, A et al. Transpterygoid transposition of a temporoparietal fascia flap: a new method for skull base reconstruction after endoscopic expanded endonasal approaches. Laryngoscope 2007;117:970–6
12Yoshioka, N, Rhoton, AL Jr.Vascular anatomy of the anteriorly based pericranial flap. Neurosurgery 2005;57(1Suppl):1116
13Price, JC, Loury, M, Carson, B, Johns, ME. The pericranial flap for reconstruction of anterior skull base defects. Laryngoscope 1988;98:1159–64
14Smith, JE, Ducic, Y. The versatile extended pericranial flap for closure of skull base defects. Otolaryngol Head Neck Surg 2004;130:704–11
15Cappabianca, P, Cavallo, LM, Esposito, F, Valente, V, de Divitiis, E. Sellar repair in endoscopic endonasal transsphenoidal surgery: Results of 170 cases. Neurosurgery 2002;51:1365–71
16Seiler, RW, Mariani, L. Sellar reconstruction with resorbable vicryl patches, gelatin foam, and fibrin glue in transsphenoidal surgery: A 10-year experience with 376 patients. J Neurosurg 2000;93:762–5
17Snyderman, CH, Janecka, IP, Sekhar, LN, Sen, CN, Eibling, DE. Anterior cranial base reconstruction: role of galeal and pericranial flaps. Laryngoscope 1990;100:607–14

Keywords

Related content

Powered by UNSILO

Technical nuances of commonly used vascularised flaps for skull base reconstruction

  • I P Tang (a1) (a2), R L Carrau (a1), B A Otto (a1), D M Prevedello (a3), P Kasemsiri (a1), L Ditzel (a3), J Muto (a3), B Kapucu (a1) and C Kirsch (a4)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.