Microsurgical Reconstruction Of Skull Base Oncologic Defects
Rachel Lentz, MD, Dhivya Srinivasa, MD, Justin Cheng, MD, William Hoffman, MD, Esther Kim, MD
UCSF, San Francisco, CA, USA.
PURPOSE: Reconstruction following surgical extirpation of skull base tumors remains a challenge to surgeons. Successful reconstructions must effectively separate the CNS from the aerodigestive tract, line the nasal cavity, and fill in substantial dead space. We review our series of 43 patients.
METHODS: We performed a retrospective review of all patients who underwent microsurgical reconstruction of skull base defects at a single institution. Patient demographics, indications, operative details, and postoperative outcomes were assessed.
RESULTS: Forty-three patients underwent microsurgical free flap reconstruction for skull base defects between 2005-2019. 81% of reconstructions were done for immediate coverage following oncologic resection. Most defects (65%) were located in the anterior cranial fossa. Flap selection included: rectus abdominis (44.2%), anterolateral thigh (30%), and radial forearm (30.2%). Recipient vessels included: superficial temporal artery (55.8%) and vein (55.8%) and facial artery (34.9%) and vein (30.23). Subcutaneous tunneling flap pedicles to reach recipient vessels was required in 28% of reconstructions. Implantable venous dopplers were utilized in 63% of reconstructions. Our overall complication rate was 40%, with 33% of patients returning to the operating room. Complications included: wound breakdown (11.6%), infection (7.0%), anastomotic compromise (4.7%), and hematoma (4.7%).
CONCLUSION: Our experience highlights the challenges encountered in performing these reconstructions. We learned that buried flaps must have adequate room to swell postoperatively; this may mean delaying bone flap replacement. Implantable dopplers should be employed in all buried flaps. Ultimately, optimal flap and recipient vessel selection is paramount to a successful free flap skull base reconstruction.
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