Salvage Skull Base Reconstruction in the Endoscopic Era: The Vastus Lateralis Free Tissue Transfer

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.

Methods Four patients with anterior skull base defects that failed prior reconstruction with locoregional flaps underwent free tissue transfer reconstruction with the vastus lateralis free tissue transfer.

Results The success rate of free tissue transfer was 100%. Complete separation of the intracranial and sinonasal cavities and resolution of CSF leakage were achieved in all patients. The vastus lateralis free tissue transfer 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.