Composite Skull Base Reconstruction Utilizing the Anterolateral Thigh Free Flap
Justin M. Sacks, MD1, Matthew M. Hanasono, MD1, Neha Goel, BS2, Martina Ayad, BS3, Roman J. Skoracki, MD1, Peirong Yu, MD,MS1.
1MD Anderson Cancer Center, Houston, TX, USA, 2University of Illinois College of Medicine, Chicago, IL, USA, 3University of Texas Medical School, Houston, TX, USA.
Purpose: Resection of skull base tumors can result in exposed bone and dura along with concomitant facial nerve and soft-tissue loss. The anterolateral thigh (ALT) free flap represents a versatile tool to reconstruct these acquired defects. We describe skull base reconstruction and dural coverage with simultaneous facial reanimation using the ALT free flap.
Methods: A retrospective review was performed for 50 patients with composite skull base defects reconstructed with the ALT free flap at a tertiary cancer center between 2002 and 2007. Patient demographics, defect characteristics, reconstructive techniques and clinical outcomes were assessed.
Results: Reconstructed sites consisted of 2 anterior, 12 lateral, and 36 posterior skull base defects. Neoadjuvant and adjuvant radiotherapy (RT) was administered to 30% and 32% of the patients, respectively. Overall complication rate was 30% (73% of these related to recipient site and 27% to donor site). One patient developed a CSF leak and one a nasocutaneous fistula. Two patients developed abscesses under the ALT flap requiring operative drainage. RT was associated with a two-fold increase in wound complications. No free flap losses occurred. Long-term donor site morbidity was not observed. Facial reanimation using 5 lateral femoral cutaneous nerve grafts and 15 static fascia lata slings were performed with free flap reconstruction. Four gold eyelid weights, 2 lateral canthoplasties, and 3 direct browlifts were also completed simultaneously. Conclusions: The ALT free flap provides reliable and versatile tissue for the reconstruction of skull base defects. The primary advantage of this flap is the ability to harvest variable amounts of skin and vastus lateralis muscle along with nerve and fascial grafts from the same operative site minimizing operative time and donor site morbidity. In our practice, the ALT flap represents a first line option for these defects.