Intracranial application of free fasciocutaneous flaps in a novel sandwich technique for skull base reconstruction

Largo, René D.; Schaefer, Dirk J.; Krueger, Jens; Harschnitz, Oliver; Zimmerer, S.; Jaquiéry, Claude; Haug, Martin; Mariani, Luigi; Kunz, Christoph

doi:10.1016/j.ijom.2011.05.013

Cited by 9 publications

(13 citation statements)

References 33 publications

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“…The lateral arm is a relatively thin, pliable flap that does not sacrifice a major artery, but has a short pedicle. 2 , 17 In contrast, the radial forearm is also thin, pliable free flap but has a much longer pedicle length. However, it is associated with disadvantages such as donor site cosmesis with necessity for a skin graft and potential numbness of the donor hand in the radial nerve distribution.…”

Section: Discussionmentioning

confidence: 99%

Use of the Omental Free Flap for Treatment of Chronic Anterior Skull Base Infections

Kokosis

Vorstenbosch

Lombardi

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Summary: Chronic complications following anterior cranial fossa tumor extirpation, such as cerebrospinal fluid leak, meningitis, mucocele, pneumocephalus, and abscess, negatively impact patient quality of life. Robust vascularized tissue is generally required to adequately reconstruct and obliterate this complex geometric space. The aim of this study was to describe outcomes and advantages of the omental flap for these defects. Following institutional review board approval, a prospective, reconstructive database was reviewed from 2011 to 2020. Four patients with chronic anterior skull base complications treated with omental flap reconstruction were identified, with chart reviews performed. Median time from the index operation until the complication ultimately required a free omental transfer was 7.3 years. All patients underwent adjuvant radiation with the indications for surgery, including cerebral abscess, recurrent meningitis, osteomyelitis, and pneumocephalus. All free flaps survived without any need for revision. There were no donor site complications. One patient had delayed healing at an adjacent nasal wound that healed secondarily. At a median follow-up of 19.4 months, none of the patients had recurrent infections. The omental free flap has a number of properties, which make it ideally suitable for anterior skull base defects. Its malleable nature combined with the presence of multiple vascular arcades enable flexibility in flap design to contour to the crevices of 3-dimensional skull base defects. Although other free flaps are available to the plastic surgeon, the versatility and reliability of the omentum make it a first-line consideration for anterior skull base reconstruction.

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Section: Discussionmentioning

confidence: 99%

Use of the Omental Free Flap for Treatment of Chronic Anterior Skull Base Infections

Kokosis

Vorstenbosch

Lombardi

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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“…Largo et al describe a folded position of this flap with osteodermal sutures for anterior and middle skull base defects with good outcomes. 24…”

Section: Lateral Arm Fasciocutaneousmentioning

confidence: 99%

Free-Flap Reconstruction of Skull Base and Orbital Defects

Wang

Vincent

Sokoya

et al. 2019

Seminars in Plastic Surgery

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Orbital and anterior skull base defects present a significant challenge for reconstruction due to the complexity of the anatomy and the need for separation of intracranial and extracranial contents in this area. While endoscopic techniques have revolutionized the treatment of many anterior skull base defects, microvascular free tissue transfer is a viable option for large volume defects not suitable for traditional open approaches or for cases where endoscopic techniques have failed. The various free tissue transfer techniques for anterior skull base and orbit, as well as the advantages and disadvantages, are reviewed.

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“…Reconstruction of large exenteration defects with involvement of the cranial base are often best addressed with free tissue transfer . Complications such as failure of primary wound healing, flap loss, meningitis, and CSF leakage are significantly lower in free tissue transfer compared with regional flaps . Selection of the appropriate flap is critical to meeting the demands of the defect and is dependent on multiple factors: surface area needed for coverage, soft and bony tissue needs, and pedicle length are all critical factors.…”

Section: Introductionmentioning

confidence: 99%

Postoperative cerebrospinal fluid leak after microvascular reconstruction of craniofacial defects with orbital exenteration

et al. 2016

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Intracranial application of free fasciocutaneous flaps in a novel sandwich technique for skull base reconstruction

Cited by 9 publications

References 33 publications

Use of the Omental Free Flap for Treatment of Chronic Anterior Skull Base Infections

Use of the Omental Free Flap for Treatment of Chronic Anterior Skull Base Infections

Free-Flap Reconstruction of Skull Base and Orbital Defects

Postoperative cerebrospinal fluid leak after microvascular reconstruction of craniofacial defects with orbital exenteration

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