Advances in vascularized flaps for skull base reconstruction

Abstract

Purpose of review Advances in anterior skull base surgery have resulted in the increasing diversification of reconstructive techniques. New vascularized flaps have been suggested in the last years, some quite similar, whereas new uses and applications have been suggested for some vascularized flaps, which have already established their value over the last decades. In this article, we describe the developments in skull base reconstruction with vascularized flaps and analyse the international experience in the use of vascularized flaps published with a focus on the last 18 months. Recent findings Over the past 18 months, a number of novel or modified vascularized intranasal flaps have been described, focusing on reconstruction of larger defects, the medial orbital wall, the anterior skull base (septal flip-flap) and dissection of the nasoseptal flap from the SPA foramen. Extranasal vascularized flaps, which have been around for a long time, still have their rightful place in skull base reconstruction and have recently been adjusted for endoscopic use. Summary We present an overview of the latest developments in vascularized flaps (intranasal and extranasal), their new implications, their modifications and complications or predictions of viability.

Endoscopic Reconstruction of the Sellar Floor by Extended Inferior Turbinate Flap in Recurrent Pituitary Tumors

“…The free tissue flap has several disadvantages in the sense that not suitable for significant defects, delayed healing could be dislodged, and the need for another incision in the donor site. A vascularized flap provides a reliable reconstruction of significant skull base defects with low rates of post-operative CSF leak when compared to free tissue grafts (6)(7)(8)(9) .…”

“…A vascularized flap provides a reliable reconstruction of significant skull base defects with low rates of postoperative CSF leak when compared with free tissue grafts. [6][7][8][9] Local vascularized flaps gained wide acceptance and became the principal reconstructive choice due to their advantages (e.g., ease of elevation, low morbidity of the donor site, low rate of complications, and the tendency for rapid and complete healing). The nasoseptal flap (NSF) has become the mainstay of endonasal reconstruction as it is versatile, has a good arc of rotation, and provides a large surface area.…”

Advances in Skull Base Reconstruction during Neuroendoscopic Transsphenoidal Pituitary Adenomectomy

“…The incidence of postoperative cerebrospinal fluid leakage is significantly reduced, especially in patients with hydrocephalus [32]. Oostra showed that the bony reconstruction of the skull base facilitated the mechanical support of the skull base and strengthened the intertissue confinement [33]. A study by Xia also pointed out that in situ bone flaps, because they are derived from autologous bone tissue, are more biocompatible with surrounding tissues and facilitate the early healing of bony structures, plus the postoperative bony reconstruction of the block patients, strengthen the rigid support of the skull base, and provide good bony conditions during periods of high risk of cerebrospinal fluid leakage [34].…”