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Vascularised local and free flaps in anterior skull base reconstruction

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Lesions of the anterior skull base often require sufficient closure in order to prevent cerebrospinal fluid (CSF) leak, ascending infection and/or brain tissue prolapse. The transfer of devitalized autologous, allogenic or xenogeneic material is not always sufficient particularly not in larger defects or in the recurrent situation. Here the transfer of vascularised tissue seems to be more appropriate. The anterior skull base with various complex defects of 41 patients was reconstructed in an interdisciplinary setting by vascularised, autologous tissue transfer. Minor defects (<2.5 cm in max. diameter), generally occurring after extended endoscopic skull base approaches (n = 26, among those meningiomas, recurrent CSF fistulas, chordoma, chondroblastoma, metastasis, nasal fistula), were reconstructed by a local, vascularized pedicled mucosal flap of the lower turbinate (n = 3) or septum (n = 23). Patients with major defects (>2.5 cm in max. diameter, n = 15), comprising those with malignoma, meningoencephalocele, aneurysmatic bone cyst and trauma, were repaired by a “sandwich technique” with a combination of calvarian split and galea periosteum flap in 10 patients, in one case with a temporalis muscle flap, while in 4 further patients free vascularised radial forearm flaps were used for revision after multiple unsuccessful operations elsewhere. After a mean follow-up time of 30.5 months 38 of the 41 cases were successfully repaired with respect to prevention and treatment of CSF leakage or brain tissue prolapse, only 3 cases needed surgical revision. The reconstruction of the anterior skull base bearing complex lesions is feasible using vascularised, autologous local and also distal tissue transfer in a close interdisciplinary cooperation.

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Authors and Affiliations

  1. Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany

    Thomas K. Hoffmann, Patrick J. Schuler, Christoph Bergmann, Götz Lehnerdt, Stefan Mattheis & Stephan Lang

  2. Department of Neurosurgery, University Hospital Essen, Essen, Germany

    Nicolai El Hindy, Oliver M. Müller, Ulrich Sure & I. Erol Sandalcioglu

  3. Department of Plastic- and Hand-Surgery, BG-Kliniken Bergmannstrost, Halle/Saale, Germany

    Robert Hierner

  4. Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Düsseldorf, Düsseldorf, Germany

    Martin Wagenmann & Jörg Schipper

  5. Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany

    Daniel Hänggi

Authors
  1. Thomas K. Hoffmann
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  2. Nicolai El Hindy
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  3. Oliver M. Müller
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  4. Patrick J. Schuler
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  5. Christoph Bergmann
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  6. Robert Hierner
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  7. Götz Lehnerdt
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  8. Stefan Mattheis
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  9. Martin Wagenmann
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  10. Jörg Schipper
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  11. Ulrich Sure
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  12. Stephan Lang
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  13. Daniel Hänggi
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  14. I. Erol Sandalcioglu
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Corresponding author

Correspondence to Thomas K. Hoffmann.

Additional information

D. Hanggi and I.E. Sandalcioglu contributed equally.

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Hoffmann, T.K., El Hindy, N., Müller, O.M. et al. Vascularised local and free flaps in anterior skull base reconstruction. Eur Arch Otorhinolaryngol 270, 899–907 (2013). https://doi.org/10.1007/s00405-012-2109-1

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  • DOI: https://doi.org/10.1007/s00405-012-2109-1

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