Reverse rotation flap for reconstruction of donor site after vascular pedicled nasoseptal flap in skull base surgery

Abstract

Endonasal skull base surgery is growing exponentially as a subspecialty. In recent years, advances in endoscopic techniques and intraoperative navigation systems have allowed us to expand the indications of endoscopic skull base surgery. Major skull base centers worldwide are addressing larger and more complex lesions using endoscopic techniques. As a consequence, the skull base defects are more challenging to reconstruct. In this report, we present a novel technique to reconstruct the denuded septum remaining after the use of the vascular pedicled nasoseptal flap. Laryngoscope, 2010

Sinonasal outcomes following endoscopic anterior skull base surgery with nasoseptal flap reconstruction: a prospective study

“…However, Caicedo-Granados et al report a reverse septal rotation flap used to cover the donor site, and document patient-reported improvements in nasal crusting, airway and quality of life, with a reduction in nasal toilets. 11 A randomised study assessing nasal airway with and without the reverse rotation flap may well enlighten us further on this subject.…”

In response to Pedicled nasoseptal flap is not the standard of care for skull base defects

“…5 Donor site morbidity has been minimized with the introduction of the reverse flap or free mucosal grafts to the donor site. 6 We have not observed any olfactory loss attributable to the flap and have not lost any flaps due to medical comorbidities. We believe that reconstruction with a vascularized flap is a better choice in patients with peripheral vascular disease and diabetes than using a nonvascularized tissue graft.…”

Endoscopic Endonasal Approach for Removal of Tuberculum Sellae Meningiomas

“…Incision and rotation of the now-exposed contralateral septal mucosa to cover the denuded septum. 29,30 6. Wide bilateral opening of the sphenoid sinus with Kerrison rongeurs and high-speed drill; extreme care is taken not to damage the pedicle of the nasoseptal flap.…”