Anterior Skull Base Reconstruction with Latissimus Dorsi Flap

Introduction: Excision of extended malignant tumors of the paranasal sinuses invading the anterior base of the skull often require reconstruction to avoid herniation of the brain, chronic liquorrhea meningitis, and brain abscess. In general it is possible to close the defect in the anterior base of the skull with a galea periosteum flap. This, however, is not suitable for large defects, which require a larger amount of tissue for closure. For this purpose, microvascular free flaps are ideal since they can be adapted to the individual situation.

Material and Methods: We prefer the latissimus dorsi flap as a muscle or a myocutaneous flap. It can be anastomosed to the temporal or the facial vein and artery. If an orbital exenteration must be performed the transplant can be used for filling out the orbital socket. If the eyelids can be preserved, we stitch them to the underlying muscle so that the patient can be supplied with an artificial eye. In the case of tumor infiltration of the eyelids, they are removed and a skin paddle over the latissimus muscle is used for reconstruction. Alternatively the transferred latissimus muscle can be covered with a split skin graft. In addition to the reconstruction of the anterior skull base and the orbit, a further advantage is the obliteration of the large surgical cavity of the paranasal sinuses which avoids, in addition to chronic inflammation and crusting, functional impairment of speech and swallowing.

Results: We report our results of anterior skull base reconstruction with the latissimus dorsi flap in 24 patients. In 19 patients we performed a primary and in 5 patients a secondary reconstruction. In 11 patients we used a myocutaneous flap and in 13 patients a muscle flap. In 1 patient there was a flap loss due to venous congestion which required secondary reconstruction.

Conclusions: The latissimus dorsi flap is a versatile transplant for reconstruction of the anterior base of the skull, which improves quality of life but not the survival rate of patients who underwent this form of reconstruction.