Selection of Free Flaps in Skull Base Reconstruction: Versatility of Perforator Flaps and New Diagnostic Imaging Devices

Objective: To provide a framework for management of skull base defects and develop an algorithm for skull base reconstruction.

Design: Retrospective chart review.

Patients and Methods: Forty-three consecutive patients (27 males, 16 females; age, 1–72 years) underwent skull base reconstruction using free flaps from 2005 to 2011. For elevation of perforator flaps, new vascular visualization devices, including indocyanine-green near-infrared camera, vein visualization device, and 320-row MDCT, were used to locate the perforators and to evaluate the patency after microvascular anastomosis and flap perfusion.

Results: Reconstruction was performed as planned in all patients. Elevated flaps included rectus abdominis flap in 29 patients, anterolateral thigh flap in 6, latissimus dorsi flaps in 5, and superficial circumflex iliac perforator flap in 3. All flaps survived completely. Complications included wound infection in five patients, hematoma in two, wound dehiscence in two, meningitis in one, and abdominal hernia in one.

Conclusions: Based on our experiences, perforator flaps are recommended for small to moderate sized defects because of low donor site morbidity. For extensive defects, conventional free flaps such as rectus abdominis flap are preferred. Perforator flap can be transferred safely and easily with the aid of new imaging devices.