Radial Forearm Free Tissue Transfer in the Management of Persistent Cerebrospinal Fluid Leaks

Abstract

Free tissue transfer is an efficacious option in the repair of recalcitrant CSF leaks.

Closure of large skull base defects after endoscopic transnasal craniotomy

“…30,35 Free vascularized grafts have been used to reconstruct craniofacial defects in complex and postradiotherapy cases with similar rates to nonvascularized repairs. 4,8,41 The complications related to the use of vascularized versus nonvascularized repairs were compared in the international collaborative study of craniofacial surgery in 1025 open cases. There was no difference in outcomes, but the analysis did no control for defect size, which would naturally preselect patients to each group.…”

Cranionasal fistula in pediatric population: Is endonasal endoscopic approach effective?

“…The reason we could achieve a high success rate in the primary surgery can be attributed to the use of vascularized middle turbinate flap and septal mucosal flap used. Various methods have been described to improve the outcome by using fibrin glue [10], hydroxyapatite [11] or the free flap [12] to reconstruct the skull base in adults but we did not use any of these methods.…”

Changing patterns of tracheotomy use in anterior skull base surgery with free tissue reconstruction

“…13 There were no cases of CSF leaks in this study. This result is not surprising because, in fact, other reports have demonstrated the utility of free tissue transfer to manage persistent CSF leaks 12 and to reduce complications in salvage skull base surgery. 11 Weber et al 12 reported their experience with 12 patients undergoing free tissue transfers for repair of CSF leaks.…”

“…[7][8][9] Despite the technical complexity free tissue reconstruction techniques, the overall complication rate of anterior skull base defects reconstructed with free tissue transfers is, at worst, similar to conventional reconstruction techniques. 7,[10][11][12] Although free tissue transfers are widely used for large anterior skull base defects, performing craniofacial resections still carries a significant morbidity. Therefore, avoidance of complications, particularly with the use of free tissue transfers, remains paramount.…”