Download PDF
J Neurol Surg B Skull Base 2022; 83(02): 125-132
DOI: 10.1055/s-0040-1718909
Original Article

Free Flap Reconstruction of the Anterior Skull Base: A Systematic Review

Rajan P. Dang 
1   Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, Saint Louis, Missouri, United States
,
Abhinav R. Ettyreddy
1   Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, Saint Louis, Missouri, United States
,
Zain Rizvi
2   Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, United States
,
Michelle Doering
3   School of Medicine, Washington University in Saint Louis, Saint Louis, Missouri, United States
,
Angela L. Mazul
1   Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, Saint Louis, Missouri, United States
,
Joseph Zenga
4   Department of Otolaryngology-Head and Neck Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
,
Ryan S. Jackson
1   Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, Saint Louis, Missouri, United States
,
Patrik Pipkorn 
1   Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, Saint Louis, Missouri, United States
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Objectives Given the limitations in the available literature, the precise indications, techniques, and outcomes of anterior skull base free flap reconstruction remain uncertain. The objective of this study was to perform a systematic review of published literature and evaluate indications, methods, and complications for anterior skull base free flap reconstruction.

Methods A systematic review of the literature was performed using a set of search criteria to identify patients who underwent free flap reconstruction of the anterior skull base. Articles were reviewed for inclusion based on relevance, with the primary outcome being surgical complications.

Results After a comprehensive search, 406 articles were obtained and 16 articles were ultimately found to be relevant to this review—79 patients undergoing free flap reconstruction were identified. Overall complication rates were 17.7% (95% confidence interval [CI]: 16.6–33.1%) for major complications and 19.0% (95% CI: 17.8–35.5%) for minor complications.

Conclusion Microvascular reconstruction of the anterior skull base is feasible with high reliability reported in the literature.

Keywords

systematic review - anterior - skull base - free flap - reconstruction


Publication History

Received: 26 January 2020

Accepted: 03 September 2020

Article published online:
18 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Hachem RA, Elkhatib A, Beer-Furlan A, Prevedello D, Carrau R. Reconstructive techniques in skull base surgery after resection of malignant lesions: a wide array of choices. Curr Opin Otolaryngol Head Neck Surg 2016; 24 (02) 91-97
    CrossrefPubMedGoogle Scholar
  • 2 Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 2003; 73 (09) 712-716
    CrossrefPubMedGoogle Scholar
  • 3 Thakker JS, Fernandes R. Evaluation of reconstructive techniques for anterior and middle skull base defects following tumor ablation. J Oral Maxillofac Surg 2014; 72 (01) 198-204
    CrossrefPubMedGoogle Scholar
  • 4 Chiu ES, Kraus D, Bui DT. et al. Anterior and middle cranial fossa skull base reconstruction using microvascular free tissue techniques: surgical complications and functional outcomes. Ann Plast Surg 2008; 60 (05) 514-520
    CrossrefPubMedGoogle Scholar
  • 5 Sinha P, Desai SC, Ha DH, Chicoine MR, Haughey BH. Extracranial radial forearm free flap closure of refractory cerebrospinal fluid leaks: a novel hybrid transantral-endoscopic approach. Neurosurgery 2012; 71 (2, Suppl Operative): discussion ons225–ons226 ons219-ons225
    PubMedGoogle Scholar
  • 6 Kang SY, Eskander A, Hachem RA. et al. Salvage skull base reconstruction in the endoscopic era: vastus lateralis free tissue transfer. Head Neck 2018; 40 (04) E45-E52
    CrossrefPubMedGoogle Scholar
  • 7 Vargo JD, Przylecki W, Camarata PJ, Andrews BT. Classification and microvascular flap selection for anterior cranial fossa reconstruction. J Reconstr Microsurg 2018; 34 (08) 590-600
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Costantino PD, Shamouelian D, Tham T, Andrews R, Dec W. The laparoscopically harvested omental free flap: a compelling option for craniofacial and cranial base reconstruction. J Neurol Surg B Skull Base 2017; 78 (02) 191-196
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Betz CS, Thon N, Rachinger W. Closure of large, secondary skull base defect following craniofacial tumor resection and adjuvant chemoradiation therapy using a free, microvascularly anastomosed radial forearm fascial graft: a case report. J Neurol Surg B Skull Base 2016; 77: PO-07
    PubMedGoogle Scholar
  • 10 Yano T, Okazaki M, Tanaka K, Iida H. The flap sandwich technique for a safe and aesthetic skull base reconstruction. Ann Plast Surg 2016; 76 (02) 193-197
    CrossrefPubMedGoogle Scholar
  • 11 Duchateau NC, Komen N, Dua G, Mertens M, Colpaert SDM. Reconstruction of the median anterior skull base with an intracranial free radial forearm flap after recurrent resection of tumour. J Plast Surg Hand Surg 2014; 48 (03) 222-224
    CrossrefPubMedGoogle Scholar
  • 12 Yeo IS, Kim SH, Park MC, Lim H, Kim JH, Lee IJ. Successful reconstruction of irradiated anterior skull base defect using the dual flap technique involving local pericranial flap and radial forearm free flap. J Craniofac Surg 2014; 25 (04) 1376-1378
    CrossrefPubMedGoogle Scholar
  • 13 Manjila S, Zender CA, Weaver J, Rodgers M, Cohen AR. Aneurysmal bone cyst within fibrous dysplasia of the anterior skull base: continued intracranial extension after endoscopic resections requiring craniofacial approach with free tissue transfer reconstruction. Childs Nerv Syst 2013; 29 (07) 1183-1192
    CrossrefPubMedGoogle Scholar
  • 14 Biron VL, Gross M, Broad R, Seikaly H, Wright ED. Radial forearm free flap with titanium mesh sandwich reconstruction in complex anterior skull base defects. J Craniofac Surg 2012; 23 (06) 1763-1765
    CrossrefPubMedGoogle Scholar
  • 15 Girod A, Boissonnet H, Jouffroy T, Rodriguez J. Latissimus dorsi free flap reconstruction of anterior skull base defects. J Craniomaxillofac Surg 2012; 40 (02) 177-179
    CrossrefPubMedGoogle Scholar
  • 16 Inman J, Ducic Y. Intracranial free tissue transfer for massive cerebrospinal fluid leaks of the anterior cranial fossa. J Oral Maxillofac Surg 2012; 70 (05) 1114-1118
    CrossrefPubMedGoogle Scholar
  • 17 Biglioli F, Beltramini GA, Rabbiosi D, Boari N, Mortini P. Microsurgical treatment of frontal mucocele sequelae. J Craniofac Surg 2011; 22 (06) 2296-2299
    CrossrefPubMedGoogle Scholar
  • 18 Guthikonda B, Hanna EY, Skoracki RJ, Prabhu SS. Ameloblastic fibrosarcoma involving the anterior and middle skull base with intradural extension. J Craniofac Surg 2009; 20 (06) 2087-2090
    CrossrefPubMedGoogle Scholar
  • 19 Zhang B, Li DZ, Xu ZG, Tang PZ. Deep inferior epigastric artery perforator free flaps in head and neck reconstruction. Oral Oncol 2009; 45 (02) 116-120
    CrossrefPubMedGoogle Scholar