Radial Forearm Free Flap with Parapharyngeal Pedicle Corridor for Reconstruction of Anterior Skull Base Defects

Porto, Edoardo; Vuncannon, Jackson; Revuelta-Barbero, J. Manuel; Rodas, Alejandra; Maldonado, Justin; Garzón-Muvdi, Tomás; Barrow, Emily M.; Pradilla, Gustavo; Solares, C. Arturo

doi:10.1016/j.wneu.2023.02.103

Cited by 2 publications

(2 citation statements)

References 9 publications

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“…While microvascular free flaps are effective in the primary reconstruction of oncologic defects, their use in the treatment of anterior skull base ORN is still less commonly implored. 7,[10][11][12][13][14][15] Here we describe the use of an anterolateral thigh free flap to successfully treat delayed onset ORN following basaloid squamous cell carcinoma (BSCC) of the sinonasal cavity. With eight reported cases in the English medical literature of extensive anterior skull base reconstruction by a microvascular free flap for osteoradionecrosis we present an important experience herein.…”

Section: Introductionmentioning

confidence: 99%

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Multidisciplinary Management of Total Anterior Skull Base Osteoradionecrosis

Dhanda,

McKee,

Allen

et al. 2023

J Neurol Surg Rep

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Cases of delayed osteoradionecrosis (ORN) of the anterior skull base have unique management considerations. A 59-year-old woman with a history of basaloid squamous cell carcinoma of the sinonasal cavity with intracranial extension through the anterior skull base developed delayed radiation sequelae of anterior skull base ORN. She underwent an initial endoscopic resection in 2011 with persistent disease that required an anterior craniofacial resection with left maxillectomy in 2012 followed by adjuvant chemoradiotherapy. She subsequently developed an intracranial abscess in 2021 along the anterior skull base that required a craniotomy and endoscopic debridement. Despite aggressive surgical and medical therapy, she had persistent intracranial infections and evidence of skull base osteoradionecrosis. She ultimately underwent a combined open bifrontal craniotomy and endoscopic resection of the necrotic frontal bone and dura followed by an anterolateral thigh free flap reconstruction with titanium mesh cranioplasty. The patient recovered well from a microvascular free-tissue reconstruction without concern for cerebrospinal fluid leak. Anterior skull base reconstruction with free tissue transfer is a commonly utilized method for oncologic resections. Here, an anterolateral free flap was effectively used to treat an anterior skull base defect secondary to a rare indication of skull base osteoradionecrosis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Multidisciplinary Management of Total Anterior Skull Base Osteoradionecrosis

Dhanda,

McKee,

Allen

et al. 2023

J Neurol Surg Rep

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Establishing a Microsurgical Practice in a Limited Resource African Setting: The Kapsowar Hospital Experience

Rhodes,

Arbuiso,

Alston

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Background: Microsurgical technique is still not readily available in many low- and middle-income countries. Few works in the scholarly literature describe the establishment of microsurgical practice on the African continent, and there are virtually no descriptions of the financial aspects of free flap performance by locally staffed teams in sub-Saharan Africa. The Kapsowar Hospital is a hospital in rural Kenya with 2 plastic and reconstructive surgeons certified by the American Board of Plastic Surgery and has recently expanded clinical practice to include microsurgical procedures. Methods: A retrospective chart review was conducted on patients who received a free flap at the Kapsowar Hospital in 2022–2023. Captured parameters included age, sex, relevant medical history, etiology of wound, flap performed, intraoperative time, complications, surgical revisions, and length of stay. Billing information for all domestic patients who received free flaps were audited, and disability-adjusted life years was calculated. Results: Nineteen free flaps were performed on 17 patients. The most common flap performed was the anterolateral thigh flap (n = 11). Flap survival rate was 94.7%. The surgical cost associated with performing an anterolateral thigh flap was $548 ± $35. The total cost associated with other free flap performances was $863 ± $269. The cost per disability-adjusted life years averted was $121, indicating that the procedure was very cost-effective. Conclusions: Despite obstacles, microsurgical practices can be safely established in limited-resource African settings. Free flaps can be performed with greater cost-efficiency when performed by local teams. Surgical mission trips should emphasize educational components and ultimately transition care to local surgeons.

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Radial Forearm Free Flap with Parapharyngeal Pedicle Corridor for Reconstruction of Anterior Skull Base Defects

Cited by 2 publications

References 9 publications

Multidisciplinary Management of Total Anterior Skull Base Osteoradionecrosis

Multidisciplinary Management of Total Anterior Skull Base Osteoradionecrosis

Establishing a Microsurgical Practice in a Limited Resource African Setting: The Kapsowar Hospital Experience

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