Plastic reconstructive surgery techniques for defect coverage of extended skull base defects

Paprottka, Felix J.; Krezdorn, Nicco; Ipaktchi, Ramin; Radtke, Christine; Vogt, Peter M.

doi:10.1016/j.bjps.2016.06.008

Cited by 8 publications

(3 citation statements)

References 17 publications

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“… 18 Finally, the latissimus dorsi is a large myocutaneous flap with a long, reliable, vascular pedicle that can be used to reconstruct particularly large defects with minimal donor site morbidity. 19 Perhaps the principal drawback with any of the aforementioned options relative to the omentum is the lack of pliability of any fasciocutaneous or muscle flap with inability to contour to the thin narrow and 3-dimensional geometry of anterior skull base defects.…”

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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“…rectus abdominis and latissimus dorsi flap being indicated for very large defects. Bone-including free flaps have also been reported for reconstruction requiring a rigid vascularized framework, with special reference to those harvested from the subscapular system due to its versatility in terms of bony and soft tissue components 89,90 . Skull base infection and osteoradionecrosis also benefit from transfer of non-infected, non-irradiated, (re-)vascularized tissue following necrosectomy and debridement, which should be delivered in the context of a comprehensive therapy includ-ing a combination of tailored antibiotics, pentoxifylline, alpha-tocopherol, and hyperbaric oxygen therapy [91][92][93] .…”

Section: Post-ablative Defects Requiring Plastic Surgical Expertisementioning

confidence: 99%

When is a multidisciplinary surgical approach required in sinonasal tumours with cranial involvement?

Ferrari

Cazzador

Taboni

et al. 2021

Acta Otorhinolaryngol Ital

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“…Extremely large skull base defects can be extremely challenging to treat, and chimeric flaps based on the LD and occasionally in conjunction with the subscapular system have been described by Paprottka et al 27 Moyer et al described a case of where the LD was used and vascular bone was avoided due to lack of likely improvement in function or cosmesis given an intact junction between the frontal bar and lateral orbital rim. 28…”

Section: Latissimus Dorsimentioning

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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Plastic reconstructive surgery techniques for defect coverage of extended skull base defects

Cited by 8 publications

References 17 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

When is a multidisciplinary surgical approach required in sinonasal tumours with cranial involvement?

Free-Flap Reconstruction of Skull Base and Orbital Defects

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