Salvage skull base reconstruction in the endoscopic era: Vastus lateralis free tissue transfer

Background When locoregional flaps fail to reconstruct the skull base, the microvascular surgeon faces several reconstructive challenges. We present our technique and results of salvage anterior skull base reconstruction utilizing the vastus lateralis free tissue transfer (VLFTT). Methods Four patie...

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Bibliographic Details
Published in:Head & neck 2018-04, Vol.40 (4), p.E45-E52
Main Authors: Kang, Stephen Y., Eskander, Antoine, Hachem, Ralph Abi, Ozer, Enver, Teknos, Theodoros N., Old, Matthew O., Prevedello, Daniel M., Carrau, Ricardo L.
Format: Article
Language:English
Subjects:
Cerebrospinal fluid
endoscopic skull base
Endoscopy
free flap
Head and neck
head and neck reconstruction
microvascular reconstruction
Microvasculature
Skull
skull base reconstruction
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Summary:Background When locoregional flaps fail to reconstruct the skull base, the microvascular surgeon faces several reconstructive challenges. We present our technique and results of salvage anterior skull base reconstruction utilizing the vastus lateralis free tissue transfer (VLFTT). Methods Four patients with anterior skull base defects after previous locoregional flap failure underwent free tissue transfer reconstruction with VLFTT. Results The success rate of free tissue transfer was 100%. Complete separation of the intracranial and sinonasal cavities was achieved in all patients; thus, resolving the cerebrospinal fluid (CSF) leakage in all patients. The VLFTT was inset through a minimally invasive approach utilizing an anterior maxillotomy via a gingivobuccal incision, an endoscopic medial maxillectomy, and endoscopic inset in all patients. No vein grafts were needed. Conclusion This technique permits endoscopic endonasal inset and placement of reliable, well vascularized free tissue that may be utilized for complex, secondary reconstruction of the skull base.
ISSN:1043-3074
1097-0347
DOI:10.1002/hed.25094