Free Tissue Transfer for Skull Base Reconstruction Analysis of Complications and a Classification Scheme for Defining Skull Base Defects

Free tissue transfer and local flap complications in anterior and anterolateral skull base surgery

“…However, in our group of patients, it is reasonable to conclude that having an intact dura does not decrease the potential for a major wound complication if the overlying reconstruction is not robust enough to tolerate high-dose, postoperative radiation therapy. Urken et al 20 also noted in their series that severe intracranial complications may occur despite minimal violation of the dura. Chang et al 24 found no association with wound complications and dural repair status.…”

“…All patients in this study had dural exposure within the surgical defect. Surgical defects were classified using a modification of the skull base defect classification system developed by Urken et al 20 Complication rates in FTT and LF reconstruction cases were analyzed separately and together. From these analyses, patterns of complications were identified.…”

“…5,9,18,20,23,24,26,28,29 In a number of reports, FTT was used preferentially to reconstruct massive defects after surgery for recurrent disease. 5,7,20,23,28 The univariate analysis demonstrated a strong association between surgery for recurrent disease and major wound complications for all patients, as well as for the subgroup of patients who were reconstructed with an LF (Tables 3 and 5). The large percentage of recurrent disease cases in many series suggests that perhaps a more aggressive initial curative intent intervention should be considered for many sinonasal tumors.…”

“…5,6,8,20,28 The most frequent complications in these reports are acute problems related to surgical closure, such as hematoma, CSF leak, and flap loss. In the recent reports in which a preponderance of local flaps were used, the complications were related more to the healing of the wound.…”

Risk Factors Associated With Repair of Orbital and Lateral Skull Defects

“…In fact, the flaps in their case series had 100% survival, and they did not believe that free flap reconstruction could create problems because of masking of recurrent disease. Another case series, performed by Urken et al, 22 demonstrated successful free tissue transfer for skull base defects in 23 of 26 patients. The other 3 patients had flap failure but underwent successful reconstruction with a second free flap.…”