Pedicled Flap Reconstruction of the Lateral Skull Base

Background: Similar to all head and neck defects, the advent and increased enthusiasm for microvascular free flap reconstruction has changed the reconstruction of the lateral skull base. As surgical techniques and expertise continue to improve, lateral skull base reconstruction continues to evolve. Microvascular techniques, however, require increased operative time, lengthened hospital stay, and adequate donor and recipient vasculature. As our population ages and comorbidities increase, there is a need for better expertise in simpler yet equally effective reconstruction of the lateral skull base.

Objective: In this paper, pedicled reconstructive options for the lateral skull base are presented. In addition, advantages and disadvantages of each technique are discussed.

Procedures: Lateral skull base defects can be reconstructed with the lower trapezius island flap, latissimus dorsi flap, supraclavicular flap, or the temporalis flap in selected patients. These options are chosen for patients in whom longer anesthesia, prolonged hospital stay, and poor vascularity increase the risk of complications with the use of microvascular free flaps.

Results: With few exceptions, the pedicled flap reconstruction of the lateral skull base is as functional and cosmetically successful when compared with free flap reconstructions.

Conclusion: Pedicled flap reconstruction of lateral skull base defects should be considered in the elderly and medically infirm patients in an effort to reduce intraoperative time, hospital stay, and potentially devastating or life-threatening complications associated with more complex reconstructive techniques.