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Skull Base 2002; 12(4): 209-214
DOI: 10.1055/s-2002-35753
CASE REPORT

Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Reconstruction of Complicated Skull Base Defects Utilizing Free Tissue Transfer

Hamid R. Djalilian, Markus Gapany, Samuel C. Levine
  • Otolaryngology-Head and Neck Surgery University of Minnesota, Minneapolis, Minnesota, and Minneapolis Veterans' Administration Medical Center, Minneapolis, Minnesota
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Publication History

Publication Date:
27 November 2002 (online)

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ABSTRACT

We managed five patients with large skull base defects complicated by complex infections with microvascular free tissue transfer. The first patient developed an infection, cerebrospinal fluid (CSF) leak, and meningitis after undergoing a translabyrinthine resection of an acoustic neuroma. The second patient had a history of a gunshot wound to the temporal bone, with a large defect and an infected cholesteatoma that caused several episodes of meningitis. The third through the fifth patients had persistent CSF leakage and infection refractory to conventional therapy. In all cases prior attempts of closure with fat grafts or regional flaps had failed. Rectus abdominis myofascial free flap, radial forearm free flap or a gracilis muscle free flap was used after debridement of the infected cavities. The CSF leaks, local infections, and meningitis were controlled within a week. In our experience, microvascular free tissue provides the necessary bulk of viable, well-vascularized tissue, which not only assures a mechanical seal but also helps clear the local infection.

KEYWORDS

F ree flap - skull base - reconstructive surgery

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