Posterior Pedicle Lateral Nasal Wall Flap: A New Reconstructive Technique for Large Defects of the Skull Base

Objectives: During the last decade we have seen a rapid expansion in the indications for expanded endoscopic approaches, resulting in larger and more complex skull base defects. Reconstructive developments, however, have lagged behind our extirpative capabilities. As complex clinical scenarios continue to challenge current reconstructive strategies, we are compelled to develop alternative techniques. In this project, we demonstrate the anatomical basis for a new posterior pedicled lateral wall flap (Carrau-Hadad [C-H] flap) for the reconstruction of median skull base defects, and present our early clinical experience.

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

Methods: Using a cadaveric model, we designed and harvested a posterior pedicle mucoperiosteal flap from the inferolateral nasal wall and nasal floor. We applied the information gained in the anatomical laboratory to reconstruct four patients with transmural defects of the skull base resulting from the endoscopic endonasal resection of one extrasellar pituitary adenoma and three recurrent chordomas.

Results: Using a cadaveric model, C-H flaps were designed, harvested, and transposed into various defects of the planum sphenoidale, sella turcica, clivus, and nasopharynx. We were able to use the C-H flap to adequately reconstruct all surgical defects at the clivus (n = 3) and sella (n = 1). All patients healed uneventfully.

Conclusions: Our anatomical dissections and early clinical experience support the use of the posterior pedicle lateral nasal wall flap to reconstruct large ventral cranial base defects in properly selected patients.