Beyond the nasoseptal flap: Outcomes and pearls with secondary flaps in endoscopic endonasal skull base reconstruction

Patel, Mihir R.; Taylor, Robert J.; Hackman, Trevor; Germanwala, Anand V.; Sasaki‐Adams, Deanna; Ewend, Matthew G.; Zanation, Adam M.

doi:10.1002/lary.24319

Cited by 119 publications

(114 citation statements)

References 32 publications

(62 reference statements)

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“…9 While describing many of these secondary options for skull base repair, Patel et al found that these repairs conferred a postoperative CSF leak rate of 3.6%, a finding comparable to the success rate of the nasoseptal flap.…”

Section: 13mentioning

confidence: 99%

“…9 A detailed description of the surgical techniques required for this diverse group of pedicled flaps is outside the scope of this review. However, it is important to note that while the nasoseptal flap remains one of the most commonly used flaps for the skull base reconstructive surgeon, a thorough understanding of secondary options and techniques for vascularized skull base repair is critical.…”

Section: Neurosurgery the University Of North Carolina At Chapel Hilmentioning

confidence: 99%

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Endoscopic skull base reconstruction: a review and clinical case series of 152 vascularized flaps used for surgical skull base defects in the setting of intraoperative cerebrospinal fluid leak

Thorp

Sreenath²,

Ebert³

et al. 2014

FOC

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148

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Endoscopic skull base surgery continues to rapidly evolve, requiring comparable advances in reconstructive techniques. While smaller skull base defects with low intraoperative CSF flow have been successfully managed with a variety of avascular and/or noncellular techniques, larger defects with high CSF flow require more robust repairs often in the form of vascularized flaps, which confer excellent success rates in this setting. Despite these successful outcomes, a paucity of data describing specific patient and operative characteristics and their effects on repair exist. Therefore, a retrospective, consecutive chart review was performed on patients who underwent endoscopic skull base reconstruction with a vascularized flap in the setting of intraoperative CSF leaks. In this series, 151 patients with a mean age of 51 years underwent 152 vascularized flap skull base reconstructions for an array of benign and malignant pathologies. These vascularized flaps included 144 nasoseptal flaps, 6 endoscopic-assisted pericranial flaps, 1 facial artery buccinator flap, and 1 inferior turbinate flap that were used throughout all regions of the skull base. Perioperative (< 3 months) and postoperative (> 3 months) flap complications were assessed and revealed 3 perioperative flap defects (2.0%) defined as a visualized defect within the substrate of the flap and a total of 5 perioperative CSF leaks (3.3%). No patient experienced flap death/complete flap loss in the cohort. Assessed postoperative flap complications included 1 case (0.7%) of mucocele formation, 8 cases (5.3%) of prolonged skull base crusting, and 2 cases (1.3%) of donor-site complication, specifically septal perforation secondary to nasoseptal flap harvest. Among the 152 cases identified, 37 patients received radiation therapy while 114 patients did not undergo radiation therapy as part of the treatment profile. No significant association was found between perioperative complication rates and radiation therapy (p = 0.634). However, a significant association was found between postoperative complication rates and radiation therapy, primarily accounted for by an increased risk for prolonged (> 6 months) skull base crusting (p = 0.025). It is clear that larger skull base defects with high intraoperative CSF flow require thoughtful approach and strong consideration for vascularized repair.

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Section: 13mentioning

confidence: 99%

Section: Neurosurgery the University Of North Carolina At Chapel Hilmentioning

confidence: 99%

Endoscopic skull base reconstruction: a review and clinical case series of 152 vascularized flaps used for surgical skull base defects in the setting of intraoperative cerebrospinal fluid leak

Thorp

Sreenath²,

Ebert³

et al. 2014

FOC

Self Cite

148

View full text Add to dashboard Cite

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“…4 Patel and his colleagues recently published their experience with secondary flaps in endoscopic endonasal skull base surgery. 5 These flaps are useful in situations when there is invasion of tumor into the nasal septum or when prior surgery or radiation has disrupted its vascular supply. At their institution, the endoscopic assisted pericranial flap was utilized for cases of sinonasal cancer with intradural involvement.…”

Section: Discussionmentioning

confidence: 99%

“…5 The inferior turbinate flap is a mucoperiosteal flap which is based on the inferior turbinate artery best utilized for clival or sellar defects. Its main pitfall is the potential disruption of the nasolacrimal duct.…”

Section: Discussionmentioning

confidence: 99%

“…Potential pitfalls are disruption of the nasolacrimal duct and difficult dissection of the inferior turbinate mucoperiosteum. 5 Khoo and colleagues have described their experience with open nasopharyngectomy with maxillary swing approach with radial forearm free flap reconstruction for recurrent nasopharyngeal carcinoma. 6 The advantages of a free flap for this purpose is that it can facilitate the healing process and minimize the risk of infection, osteoradionecrosis, and carotid rupture.…”

Section: Discussionmentioning

confidence: 99%

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Reconstructive Flaps After Salvage Nasopharyngectomy

Thakkar¹,

Grossman²,

Lin³

et al. 2016

Otolaryngol Open J.

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Importance: The emergence of new technologies for early diagnosis of recurrent nasopharyngeal cancer and new techniques of endoscopic nasopharyngectomy increase the incidence of salvage nasopharyngectomy and pose the question of the ideal flap for reconstruction of this defect. Objectives: A review of the literature to identify the flaps used in nasopharyngeal reconstruction and their advantages and disadvantages, characteristics, and outcomes. Methods: We reviewed the literature available in the English language to identify the various flaps used, their indications and surgical technique, complications and outcomes. Results: Multiple flaps have been used. Local mucosal flaps such as the posterior pedicled middle turbinate mucoperiosteal flap, the posterior pedicled Nasal Septal Flap (NSF) and Floor mucoperiosteum flap (FF), pedicled flaps such as the extended glabellar fascial cutaneous flap, the Haddad-Bassagasteguy flap, the temporoparietal fascial flap and the pericranial flap and free flaps such as the radial forearm and vastus lateralis flap have been described. These flaps are used depending on the specific defect characteristics and tissue available for reconstruction. The advantages and disadvantages of these flaps are discussed. Conclusion: No single flap is ideal for all cases. The choice of flap will have to be tailored according to the patient, the defect created, consistent with oncologic principles, donor site availability and surgeon preference. A working knowledge of available flaps is essential to provide coverage of the skull base to avoid vascular and infectious complications.

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Outcomes of Nasal Septal Perforation Repair Using Combined Temporoparietal Fascia Graft and Polydioxanone Plate Construct

Morse

Harris

Owen

et al. 2019

JAMA Facial Plast Surg

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IMPORTANCE Numerous techniques are used for septal perforation repair, yet success rates remain variable. Few studies have evaluated the effectiveness of interposition grafts of polydioxanone plates combined with a temporoparietal fascia graft for septal perforation repair.OBJECTIVE To investigate and describe the use of interposition grafts of polydioxanone plates combined with a temporoparietal fascia graft for septal perforation repair and the expansion of this technique to patients with more challenging comorbidities, including granulomatosis with polyangiitis. DESIGN, SETTING, AND PARTICIPANTSA retrospective medical record review was performed of patients who underwent septal perforation repair using interposition grafts of polydioxanone plates combined with a temporoparietal fascia graft from

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Beyond the nasoseptal flap: Outcomes and pearls with secondary flaps in endoscopic endonasal skull base reconstruction

Abstract: 4.

Cited by 119 publications

References 32 publications

Endoscopic skull base reconstruction: a review and clinical case series of 152 vascularized flaps used for surgical skull base defects in the setting of intraoperative cerebrospinal fluid leak

Endoscopic skull base reconstruction: a review and clinical case series of 152 vascularized flaps used for surgical skull base defects in the setting of intraoperative cerebrospinal fluid leak

Reconstructive Flaps After Salvage Nasopharyngectomy

Outcomes of Nasal Septal Perforation Repair Using Combined Temporoparietal Fascia Graft and Polydioxanone Plate Construct

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