Free-Flap Reconstruction of Skull Base and Orbital Defects

Abstract

Orbital and anterior skull base defects present a significant challenge for reconstruction due to the complexity of the anatomy and the need for separation of intracranial and extracranial contents in this area. While endoscopic techniques have revolutionized the treatment of many anterior skull base defects, microvascular free tissue transfer is a viable option for large volume defects not suitable for traditional open approaches or for cases where endoscopic techniques have failed. The various free tissue transfer techniques for anterior skull base and orbit, as well as the advantages and disadvantages, are reviewed.

Keywords

free-flap reconstruction - skull base surgery - microvascular reconstruction

• References

• 1 Schmidt RF, Choudhry OJ, Takkellapati R, Eloy JA, Couldwell WT, Liu JK. Hermann Schloffer and the origin of transsphenoidal pituitary surgery. Neurosurg Focus 2012; 33 (02) E5
• 2 Ketcham AS, Hoye RC, Van Buren JM, Johnson RH, Smith RR. Complications of intracranial facial resection for tumors of the paranasal sinuses. Am J Surg 1966; 112 (04) 591-596
• 3 Urken ML, Catalano PJ, Sen C, Post K, Futran N, Biller HF. Free tissue transfer for skull base reconstruction analysis of complications and a classification scheme for defining skull base defects. Arch Otolaryngol Head Neck Surg 1993; 119 (12) 1318-1325
• 4 Kraus DH, Shah JP, Arbit E, Galicich JH, Strong EW. Complications of craniofacial resection for tumors involving the anterior skull base. Head Neck 1994; 16 (04) 307-312
• 5 Catalano PJ, Hecht CS, Biller HF. , et al. Craniofacial resection. An analysis of 73 cases. Arch Otolaryngol Head Neck Surg 1994; 120 (11) 1203-1208
• 6 Irish JC, Gullane PJ, Gentili F. , et al. Tumors of the skull base: outcome and survival analysis of 77 cases. Head Neck 1994; 16 (01) 3-10
• 7 Janecka IP, Sen C, Sekhar LN. , et al. Cranial base surgery: results in 183 patients. Otolaryngol Head Neck Surg 1994; 110 (06) 539-546
• 8 Clayman GL, DeMonte F, Jaffe DM. , et al. Outcome and complications of extended cranial-base resection requiring microvascular free-tissue transfer. Arch Otolaryngol Head Neck Surg 1995; 121 (11) 1253-1257
• 9 Neligan PC, Mulholland S, Irish J. , et al. Flap selection in cranial base reconstruction. Plast Reconstr Surg 1996; 98 (07) 1159-1166 , discussion 1167–1168
• 10 McCutcheon IE, Blacklock JB, Weber RS. , et al. Anterior transcranial (craniofacial) resection of tumors of the paranasal sinuses: surgical technique and results. Neurosurgery 1996; 38 (03) 471-479 , discussion 479–480
• 11 Shah JP, Kraus DH, Bilsky MH, Gutin PH, Harrison LH, Strong EW. Craniofacial resection for malignant tumors involving the anterior skull base. Arch Otolaryngol Head Neck Surg 1997; 123 (12) 1312-1317
• 12 Dias FL, Sá GM, Kligerman J. , et al. Complications of anterior craniofacial resection. Head Neck 1999; 21 (01) 12-20
• 13 Solero CL, DiMeco F, Sampath P. , et al. Combined anterior craniofacial resection for tumors involving the cribriform plate: early postoperative complications and technical considerations. Neurosurgery 2000; 47 (06) 1296-1304 , discussion 1304–1305
• 14 Chang DW, Langstein HN, Gupta A. , et al. Reconstructive management of cranial base defects after tumor ablation. Plast Reconstr Surg 2001; 107 (06) 1346-1355 , discussion 1356–1357
• 15 Heth JA, Funk GF, Karnell LH. , et al. Free tissue transfer and local flap complications in anterior and anterolateral skull base surgery. Head Neck 2002; 24 (10) 901-911 , discussion 912
• 16 Inman J, Ducic Y. Intracranial free tissue transfer for massive cerebrospinal fluid leaks of the anterior cranial fossa. J Oral Maxillofac Surg 2012; 70 (05) 1114-1118
• 17 Pryor SG, Moore EJ, Kasperbauer JL. Orbital exenteration reconstruction with rectus abdominis microvascular free flap. Laryngoscope 2005; 115 (11) 1912-1916
• 18 O'Connell DA, Teng MS, Mendez E, Futran ND. Microvascular free tissue transfer in the reconstruction of scalp and lateral temporal bone defects. Craniomaxillofac Trauma Reconstr 2011; 4 (04) 179-188
• 19 Browne JD, Burke AJ. Benefits of routine maxillectomy and orbital reconstruction with the rectus abdominis free flap. Otolaryngol Head Neck Surg 1999; 121 (03) 203-209
• 20 Marchetti C, Gessaroli M, Cipriani R, Contedini F, Frattarelli M, Staffa G. Use of “perforator flaps” in skull base reconstruction after tumor resection. Plast Reconstr Surg 2002; 110 (05) 1303-1309
• 21 Kang SY, Spector ME, Chepeha DB. Perforator based rectus free tissue transfer for head and neck reconstruction: new reconstructive advantages from an old friend. Oral Oncol 2017; 74: 163-170
• 22 Hanasono MM, Sacks JM, Goel N, Ayad M, Skoracki RJ. The anterolateral thigh free flap for skull base reconstruction. Otolaryngol Head Neck Surg 2009; 140 (06) 855-860
• 23 Malata CM, Tehrani H, Kumiponjera D, Hardy DG, Moffat DA. Use of anterolateral thigh and lateral arm fasciocutaneous free flaps in lateral skull base reconstruction. Ann Plast Surg 2006; 57 (02) 169-175 , discussion 176
• 24 Largo RD, Schaefer DJ, Krueger J. , et al. Intracranial application of free fasciocutaneous flaps in a novel sandwich technique for skull base reconstruction. Int J Oral Maxillofac Surg 2011; 40 (09) 931-937
• 25 Disa JJ, Pusic AL, Hidalgo DH, Cordeiro PG. Simplifying microvascular head and neck reconstruction: a rational approach to donor site selection. Ann Plast Surg 2001; 47 (04) 385-389
• 26 Yeo IS, Kim SH, Park MC, Lim H, Kim JH, Lee IJ. Successful reconstruction of irradiated anterior skull base defect using the dual flap technique involving local pericranial flap and radial forearm free flap. J Craniofac Surg 2014; 25 (04) 1376-1378
• 27 Paprottka FJ, Krezdorn N, Ipaktchi R, Radtke C, Vogt PM. Plastic reconstructive surgery techniques for defect coverage of extended skull base defects. J Plast Reconstr Aesthet Surg 2016; 69 (09) 1266-1274
• 28 Moyer JS, Chepeha DB, Prince ME, Teknos TN. Microvascular reconstruction of the orbital complex. Facial Plast Surg Clin North Am 2009; 17 (02) 225-237
• 29 Barrow DL, Nahai F, Tindall GT. The use of the greater omentum vascularized free flap for neurosurgical disorders requiring reconstruction. J Neurosurg 1984; 22: 573-580
• 30 Saltz R, Stowers R, Smith M, Gadacz TR. Laparoscopically harvested omental free flap to cover a large soft tissue defect. Ann Surg 1993; 217 (05) 542-546 , discussion 546–547
• 31 Costantino PD, Shamouelian D, Tham T, Andrews R, Dec W. The laparoscopically harvested omental free flap: a compelling option for craniofacial and cranial base reconstruction. J Neurol Surg B Skull Base 2017; 78 (02) 191-196
• 32 Granick MS, Ramasastry SS, Newton ED, Solomon MP, Hanna DC, Kaltman S. Reconstruction of complex maxillectomy defects with the scapular-free flap. Head Neck 1990; 12 (05) 377-385
• 33 Swartz WM, Banis JC, Newton ED, Ramasastry SS, Jones NF, Acland R. The osteocutaneous scapular flap for mandibular and maxillary reconstruction. Plast Reconstr Surg 1986; 77 (04) 530-545
• 34 Brown JS. Deep circumflex iliac artery free flap with internal oblique muscle as a new method of immediate reconstruction of maxillectomy defect. Head Neck 1996; 18 (05) 412-421
• 35 Anthony JP, Foster RD, Sharma AB, Kearns GJ, Hoffman WY, Pogrel MA. Reconstruction of a complex midfacial defect with the folded fibular free flap and osseointegrated implants. Ann Plast Surg 1996; 37 (02) 204-210
• 36 Futran ND, Wadsworth JT, Villaret D, Farwell DG. Midface reconstruction with the fibula free flap. Arch Otolaryngol Head Neck Surg 2002; 128 (02) 161-166
• 37 Waits CA, Toby EB, Girod DA, Tsue TT. Osteocutaneous radial forearm free flap: long-term radiographic evaluation of donor site morbidity after prophylactic plating of radius. J Reconstr Microsurg 2007; 23 (07) 367-372
• 38 Werle AH, Tsue TT, Toby EB, Girod DA. Osteocutaneous radial forearm free flap: its use without significant donor site morbidity. Otolaryngol Head Neck Surg 2000; 123 (06) 711-717
• 39 Kryzanski JT, Annino DJ, Gopal H, Heilman CB. Low complication rates of cranial and craniofacial approaches to midline anterior skull base lesions. Skull Base 2008; 18 (04) 229-241