Anterior Pedicle Lateral Nasal Wall Flap: A Novel Technique for the Reconstruction of Anterior Skull Base Defects

Objectives: Expansion of the clinical indications for ablative endoscopic endonasal approaches has behooved us to search for new reconstruction alternatives. We present the anatomic foundations of a novel anterior pedicled lateral wall flap (Hadad-Bassagaisteguy 2 [HB2] flap) for the vascularized reconstruction of anterior skull base defects.

Study Design: The study consists of an anatomical description, feasibility study, and technical report.

Methods: Using a cadaveric model, we investigated the feasibility of harvesting an anteriorly based mucoperiosteal flap from the lateral nasal wall. We then applied the techniques developed in the anatomical laboratory to reconstruct four patients with extensive defects of the anterior skull base. Our experience included two patients with defects resulting from the endoscopic endonasal resection of esthesioneuroblastomas, one patient with an extensive meningoencephalocele of the anterior cranial fossa, and one patient with a large defect of the anterior skull base secondary to closed head trauma. Two of these reconstructions were combined with a Hadad-Bassagaisteguy nasoseptal 2 (HB2) flap.

Results: HB2 flaps were harvested and transposed to reconstruct anterior skull base defects in cadaveric specimens, and, subsequently, in four patients. The HB2 flap provided adequate coverage in the cadaveric model, as well as clinically in our four patients. Their postoperative healing was uneventful.

Conclusions: The HB2 flap is a feasible alternative for the reconstruction of anterior skull base defects in select patients.