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Salvage skull base reconstruction in the endoscopic era: Vastus lateralis free tissue transfer
Author(s) -
Kang Stephen Y.,
Eskander Antoine,
Hachem Ralph Abi,
Ozer Enver,
Teknos Theodoros N.,
Old Matthew O.,
Prevedello Daniel M.,
Carrau Ricardo L.
Publication year - 2018
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.25094
Subject(s) - skull , medicine , free flap , surgery , cerebrospinal fluid leakage , cerebrospinal fluid , anatomy , pathology
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.