Immediate Reconstruction of Midfacial Defects with Osteofascial and Osteocutaneous Free Flaps following Oncological Anterior Skull Base Surgery

Background: Free tissue transfer is commonly used in head and neck reconstruction to restore both form and function following tumor excision. Although, the use of vascularized bone is widely reported in mandibular reconstruction, there is a paucity of literature on the use of osteocutaneous or osteofascial free flaps in facial reconstruction. Free tissue transfer offers both theoretical and practical advantages despite the morbidity associated with increased operative time and potential flap failure. Methods: Retrospective review of a prospectively collected head and neck reconstruction database. Subsequent case note review. Results: We describe the clinical presentation, reconstructive options, and clinical course of five patients who each underwent free flap reconstruction of an anterior skull base defect using bony tissue to replicate midfacial structures. Two patients had nasal bone reconstruction using osteofascial radial forearm free flap reconstruction. Three patients required osteofascial and osteocutaneous fibula and radial forearm free flaps to reconstruct a combination of nasal and malar defects involving the zygoma, maxilla, and mandibular ramus. There was no flap failure. Conclusions: The transfer of vascularized bony tissue in anterior skull base reconstruction is both safe and practical; “like for like” tissue reconstruction may provide superior cosmetic and functional outcomes.