Axial Subcutaneous Scalp Flaps in the Reconstruction of the Anterior Cranial Fossa

Abstract

\s=b\A major concern following combined craniofacial resection of neoplasms involving the floor of the anterior cranial fossa is the creation of a watertight separation between the contents of the anterior cranial fossa and the upper aerodigestive tract. The reconstructive technique should satisfy several goals, which we will outline. The axial subcutaneous scalp flap meets these goals and has proved to be useful in reconstruction of the anterior skull base. We used the axial subcutaneous scalp flap for this purpose in three patients. Herein, we report our experience and emphasize the importance of the vascular pattern of the anterior scalp.

Primary Repair of Posteriorly Located Anterior Skull Base Dural Defects Using Nonpenetrating Titanium Clips in Cranial Trauma

“…7,[12][13][14][15] Newer developments, such as expanded endoscopic endonasal repair techniques and the use of bipedicled pericranial flaps, have proven useful in achieving this goal. 8,[16][17][18][19] In our opinion, there is little doubt in the effectiveness of endoscopic techniques for repair of well-defined defects. Trauma patients commonly present unique challenges compared with those presenting with spontaneous CSF rhinorrhea.…”

Primary Repair of Posteriorly Located Anterior Skull Base Dural Defects Using Nonpenetrating Titanium Clips in Cranial Trauma

“…7,[12][13][14][15] Newer developments, such as expanded endoscopic endonasal repair techniques and the use of bipedicled pericranial flaps, have proven useful in achieving this goal. 8,[16][17][18][19] In our opinion, there is little doubt in the effectiveness of endoscopic techniques for repair of well-defined defects. Trauma patients commonly present unique challenges compared with those presenting with spontaneous CSF rhinorrhea.…”

Surgical technique for repair of complex anterior skull base defects

“…then described what probably is the most commonly utilized method of reconstructing the anterior skull base today, which involves the pericranial flap. [ 18 ] The appeal of this flap comes from its ease of harvesting (no second incision), rich blood supply, and minimal cosmetic disturbance. Recent modifications of the pericranial flap include the galeal-pericranial and galeal frontalis myofacial flaps, which add more layers to the construct.…”

Successful Repair of Large Skull Base Defect Following JNA Excision

“…Preservation of the supraorbital and supratrochlear arteries is critical in maintaining vascularity to galeopericranial flaps. 3 Unfortunately, the blood vessels of the anterior skull base are not of sufficient caliber to allow microvascular anastomosis, and free flaps require that the vascular pedicle be extended to distant areas such as the upper neck or to the lateral face where larger vessels can be found. 4 Blood supply to the extracranial soft tissues, middle cranial fossa is via branches of the terminal branches of the external carotid artery.…”

“…• Grafts -Skin -Fascia -Fat or dermis-fat -Allografts-Dura, dermis, bone • Local flaps [1][2][3][4][5] -Forehead and scalp flaps-Cutaneous -Galeal-pericranial-Fascial -Temporal system-Muscle, fascial, osseus -Septonasal -Mucosal • Regional flaps 6,7 -Pectoralis major-Myocutaneous -Latissimus dorsi-Myocutaneous -Inferior trapezius-Myocutaneous • Revascularized free flaps [8][9][10][11] -Radial forearm-Fasciocutaneous -Rectus abdominis-Myofasciocutaneous -Subscapular-Osseo/myofasciocutaneous -Latissimus dorsi-Myocutaneous -Gastro-omental-Fascial/mucosal Rectus abdominis flaps are based on the deep inferior epigastric artery and vein and can be harvested as either a myogenous or a myofasciocutaneous flap. Early in the application of free revascularized flap reconstruction to skull base defects, the rectus abdominis flap became the workhorse free flap for anterior and middle cranial base reconstruction.…”

Primary Repair of Posteriorly Located Anterior Skull Base Dural Defects Using Nonpenetrating Titanium Clips in Cranial Trauma

“…7,[12][13][14][15] Newer developments, such as expanded endoscopic endonasal repair techniques and the use of bipedicled pericranial flaps, have proven useful in achieving this goal. 8,[16][17][18][19] In our opinion, there is little doubt in the effectiveness of endoscopic techniques for repair of well-defined defects. Trauma patients commonly present unique challenges compared with those presenting with spontaneous CSF rhinorrhea.…”

Surgical technique for repair of complex anterior skull base defects

“…then described what probably is the most commonly utilized method of reconstructing the anterior skull base today, which involves the pericranial flap. [ 18 ] The appeal of this flap comes from its ease of harvesting (no second incision), rich blood supply, and minimal cosmetic disturbance. Recent modifications of the pericranial flap include the galeal-pericranial and galeal frontalis myofacial flaps, which add more layers to the construct.…”

Successful Repair of Large Skull Base Defect Following JNA Excision

“…Preservation of the supraorbital and supratrochlear arteries is critical in maintaining vascularity to galeopericranial flaps. 3 Unfortunately, the blood vessels of the anterior skull base are not of sufficient caliber to allow microvascular anastomosis, and free flaps require that the vascular pedicle be extended to distant areas such as the upper neck or to the lateral face where larger vessels can be found. 4 Blood supply to the extracranial soft tissues, middle cranial fossa is via branches of the terminal branches of the external carotid artery.…”

“…• Grafts -Skin -Fascia -Fat or dermis-fat -Allografts-Dura, dermis, bone • Local flaps [1][2][3][4][5] -Forehead and scalp flaps-Cutaneous -Galeal-pericranial-Fascial -Temporal system-Muscle, fascial, osseus -Septonasal -Mucosal • Regional flaps 6,7 -Pectoralis major-Myocutaneous -Latissimus dorsi-Myocutaneous -Inferior trapezius-Myocutaneous • Revascularized free flaps [8][9][10][11] -Radial forearm-Fasciocutaneous -Rectus abdominis-Myofasciocutaneous -Subscapular-Osseo/myofasciocutaneous -Latissimus dorsi-Myocutaneous -Gastro-omental-Fascial/mucosal Rectus abdominis flaps are based on the deep inferior epigastric artery and vein and can be harvested as either a myogenous or a myofasciocutaneous flap. Early in the application of free revascularized flap reconstruction to skull base defects, the rectus abdominis flap became the workhorse free flap for anterior and middle cranial base reconstruction.…”

Primary Repair of Posteriorly Located Anterior Skull Base Dural Defects Using Nonpenetrating Titanium Clips in Cranial Trauma

“…7,[12][13][14][15] Newer developments, such as expanded endoscopic endonasal repair techniques and the use of bipedicled pericranial flaps, have proven useful in achieving this goal. 8,[16][17][18][19] In our opinion, there is little doubt in the effectiveness of endoscopic techniques for repair of well-defined defects. Trauma patients commonly present unique challenges compared with those presenting with spontaneous CSF rhinorrhea.…”

Surgical technique for repair of complex anterior skull base defects

“…then described what probably is the most commonly utilized method of reconstructing the anterior skull base today, which involves the pericranial flap. [ 18 ] The appeal of this flap comes from its ease of harvesting (no second incision), rich blood supply, and minimal cosmetic disturbance. Recent modifications of the pericranial flap include the galeal-pericranial and galeal frontalis myofacial flaps, which add more layers to the construct.…”

Successful Repair of Large Skull Base Defect Following JNA Excision

“…Preservation of the supraorbital and supratrochlear arteries is critical in maintaining vascularity to galeopericranial flaps. 3 Unfortunately, the blood vessels of the anterior skull base are not of sufficient caliber to allow microvascular anastomosis, and free flaps require that the vascular pedicle be extended to distant areas such as the upper neck or to the lateral face where larger vessels can be found. 4 Blood supply to the extracranial soft tissues, middle cranial fossa is via branches of the terminal branches of the external carotid artery.…”

“…• Grafts -Skin -Fascia -Fat or dermis-fat -Allografts-Dura, dermis, bone • Local flaps [1][2][3][4][5] -Forehead and scalp flaps-Cutaneous -Galeal-pericranial-Fascial -Temporal system-Muscle, fascial, osseus -Septonasal -Mucosal • Regional flaps 6,7 -Pectoralis major-Myocutaneous -Latissimus dorsi-Myocutaneous -Inferior trapezius-Myocutaneous • Revascularized free flaps [8][9][10][11] -Radial forearm-Fasciocutaneous -Rectus abdominis-Myofasciocutaneous -Subscapular-Osseo/myofasciocutaneous -Latissimus dorsi-Myocutaneous -Gastro-omental-Fascial/mucosal Rectus abdominis flaps are based on the deep inferior epigastric artery and vein and can be harvested as either a myogenous or a myofasciocutaneous flap. Early in the application of free revascularized flap reconstruction to skull base defects, the rectus abdominis flap became the workhorse free flap for anterior and middle cranial base reconstruction.…”