Pericranial flap for the closure of defects of craniofacial resections.

Abstract

Malignant neoplasms involving the ethmoid sinuses mandate en bloc resection via the craniofacial approach. This technique leaves a direct communication between the nasal chamber and the extradural space to be closed. The elevation of dura from the nasal chamber and the extradural space to be closed. The elevation of dura from the anterior chamber and the extradural space to be closed. The elevation of dura from the anterior cranial fossa and cribriform area may result in small dural tears, CSF leak and/or CNS infections. We have utilized an inferiorly based pericranial flap and a laterally based osteoplastic bone flap to successfully close this space and dural defects. The laterally based bone flap allows insetting pericranial flap without compromising the vascularized inferior base and gives generous exposure of the area to be resected. This approach has been used successfully in four patients in the last year. Three patients had esthesioneuroblastomas and the fourth had a squamous cell carcinoma of the maxilloethmoid complex. This communication describes the technique and lists advantages of the inferiorly based pericranial flap.

Surgical anatomy and utility of pedicled vascularized tissue flaps for multilayered repair of skull base defects

“…14,18,20 Classic repair of the anterior skull base uses an anteriorly based pericranial flap as the primary means to repair anterior cranial floor defects due to multiple etiologies. 3,21,23,33,35 Its popularity can be attributed to various factors. It is an easy flap to harvest, and it does not often require additional incisions.…”

“…For this reason, pedicled flaps, such as the anteriorly based pericranial, temporoparietal fascial, temporalis muscle, and galeopericranial flaps, are frequently used to reconstruct the cranial base. 6,7,9,[15][16][17]19,23,24,26,31,32,37 More recently, endoscopic endonasal approaches have been popularized and a vascular pedicled flap of the nasal septum based on the nasoseptal artery (Hadad-Bassagasteguy flap or nasoseptal flap [NSF]) has also been introduced for skull base repair and is used extensively. 17,24 The aim of this report is to detail the surgical and anatomical properties of these versatile pedicled tissue flaps and to establish the technical nuances for multilayered skull base repair in clinical cases where these flaps may be used in combination.…”

Novel Use of Unilateral Galeopericranial Flaps for Closure of Sino‐Orbital Cutaneous Fistulas

“…The "pericranium" consists of the scalp periosteum and the subgaleal areolar tissue. 9 The galea aponeurotica is a layer of dense fibrous tissue that fuses with the frontalis muscle anteriorly, the occipitalis muscle posteriorly and is contiguous with the temporoparietal fascia at its superior aspect. 16 …”

“…10 In several series describing the flap for skull base defect closure and ophthalmologic procedures, none have reported flap failure. 1,[8][9][10][11][12][13]15,16 The flap has a rich, redundant vascular supply and a thin, pliable nature. This provides the surgeon with an abundance of applications ranging from nasal reconstruction to repairing oral and oropharyngeal defects.…”

Use of Modified Pericranial Flaps in Anterior Skull Base Reconstruction: Technical Note

“…Whether created by trauma, tumor resection, or the surgical approach itself, such defects may be repaired, at least in part, using living, vascularized pericranial flaps based on the supraorbital or superficial temporal vessels. [1][2][3][4][5] Such flaps have the advantages of being locally available at the time of craniotomy, well vascularized, and adaptable to the shape of the anatomic defect.…”