Chimeric Anterolateral Thigh Flap in Skull Base Reconstruction: A Case-Based Update and Literature Review

Abstract

Oncologic and traumatic neurosurgery may have to cope with the issue of skull base defects, which are associated with increased risk of meningitis, epidural abscess and cerebro-spinal fluid (CSF) leak. The aim of skull base reconstruction is to repair the dural exposure and to separate the intracranial contents from the nonsterile sino-nasal cavities and extracranial space. Currently, many different surgical techniques have been described, and one of the most performed is the use free flap. In the present paper we performed a case-based update and literature review of the use of chimeric anterolateral thigh free flap harvested from rectus femoris, reporting the case of a 68-year-old man with recurrent spheno-ethmoidalis plane meningioma.

Scalp and Dural Reconstruction With a Tensor Fascia Lata Myofascial and Anterolateral Thigh Fasciocutaneous Chimeric Flap: A Case Report

“…1,5 A chimeric ALT flap can incorporate vastus lateralis or rectus femoris can for additional soft tissue bulk. 1,5 Relative ease of harvest, low donor site morbidity, long vascular pedicle, and ability of a 2-team approach make this flap an ideal choice for this purpose. 1,12 However, several problems arise with the use of a chimeric ALT flap when reconstructing a composite scalp defect with missing dura and soft tissue coverage.…”

“…1,5 Relative ease of harvest, low donor site morbidity, long vascular pedicle, and ability of a 2-team approach make this flap an ideal choice for this purpose. 1,12 However, several problems arise with the use of a chimeric ALT flap when reconstructing a composite scalp defect with missing dura and soft tissue coverage. First, the pedicle must pass from the underside of the fascia to facilitate extracranial anastomosis which would prevent a watertight dural repair.…”

“…The goals of reconstruction are to protect intracranial contents, prevent cerebrospinal fluid (CSF) leak and infection, and to provide durable soft tissue coverage. 1,2 Soft tissue reconstruction of simple scalp defects with exposed calvarium can be accomplished with complex closure or local scalp flaps. Large defects with high-risk features including infection, radiation, and multiple prior surgeries are best served with free tissue transfer.…”

“…Large defects with high-risk features including infection, radiation, and multiple prior surgeries are best served with free tissue transfer. 1,[3][4][5][6][7][8][9] Concomitant dural defects require additional reconstruction with a watertight closure to separate the brain parenchyma and CSF from the overlying soft tissue. 3 Cranioplasty is typically staged in the setting of active infection in order to reduce risks of complications.…”

“…The goals of reconstruction are to protect intracranial contents, prevent cerebrospinal fluid (CSF) leak and infection, and to provide durable soft tissue coverage. 1,2…”