Anterolateral thigh free flap in reconstruction of lateral skull base defects after oncological resection

Abstract

PurposeEvaluation of the utility of the free anterolateral thigh flap reconstruction of the defects resulting from radical temporal bone resection in the management of lateral skull base malignancies in a single institution.MethodsAn analysis of 17 en bloc subtotal petrosectomies for removal of malignant tumours was performed. There were 12 squamous cell carcinomas, 4 basal cell carcinomas and 1 adenoid cystic carcinoma. The tumours were staged with the University of Pittsburgh TNM system. In all patients, the lateral temporal bone with the preservation of the petrous apex and carotid artery was performed. All patients had parotid gland resection. The post-resection defect was reconstructed with an ALT free flap.ResultsTumour radical resection and defect reconstruction with an ALT flap was achieved in all patients without intraoperative complications. The transplants were harvested as fasciocutaneous flaps, 11 perfused by musculocutaneous and 6 by septocutaneous perforators. The ALT flaps had a mean pedicle length of 8 cm (6–12 cm), and the flap size ranged between 6 × 15 cm and 15 × 30 cm. The flaps were supplied by nine facial, five occipital and three maxillary arteries. Recipient-site veins included eight internal jugular, seven facial, one retromandibular and one external jugular vein. All arterial pedicles were anastomosed in an end-to-end manner. The veins were anastomosed with interrupted sutures and in 11 cases with Synovis-Coupler® devices. All the flap transfers were performed successfully. Three patients experienced postoperative complications.ConclusionsThe ALT flap proved to be effective for covering large temporal skull base defects resulting from the radical removal of temporal bone malignancies. The functional and cosmetic results were acceptable with a low complication rate.

Free flap transfer, a safe and efficient method for reconstruction of composite skull base defects after salvage resection of advanced intra- and extracranial communicating tumors

“…Many publications have reported postoperative complications of free ap for skull base reconstruction and its risk factors. The overall complication rate of a variety of the free aps is 10-32%, and partial or complete ap failure occurs in 2-9% [3,25,26,12,7,27]. The overall incidence of complications in this series was 17.6% and the rate of ap loss was 5.9%, which compared well with the literature.…”

“…In the present series, the ALT ap was used in all but 2 of the cases to reconstruct composite skull base defects. The ALT ap has been described more frequently in the last decades' publications [3]. The ALT ap, based on the descending branch of the lateral circum ex femoral artery, has many advantages of RAM ap such as reliability, long vascular pedicles, versatility in the components and two team approach.…”

“…Reconstruction of skull base should preserve residual functions, reduce morbidity and have ability to tolerate postoperative radiotherapy with acceptable cosmetic effect [3]. Non-vascularized grafts or locoregional aps are effective in patients treated with limited resection.…”

Clinial Features, Individualized Treatment and Long-Term Surgical Outcomes of Skull Base Meningiomas With Extracranial Extensions

“…However, it has been reported that the failure rate of free flap repair is 2–9% ( 38 ). Advanced age and cardiovascular disease proved to increase the risk of flap ischemia ( 38 ). In the group, there is a patient with high risk of thrombosis who developed both necrosis of the flap and cerebral infarction after operation.…”

“…The flap can be harvested without changing intraoperative positioning, which allows both the recipient-site team and the donor-site team to operate simultaneously. Some studies have confirmed the effectiveness of the anterolateral thigh flap in repairing large skull base defects (29,38). However, it has been reported that the failure rate of free flap repair is 2-9% (38).…”