Outcomes following Microvascular Free Tissue Transfer in Reconstructing Skull Base Defects

Jose L. Llorente; Fernando Lopez; Daniel Camporro; Angel Fueyo; Juan C. Rial; Ramon Fernandez de Leon; Carlos Suarez

doi:10.1055/s-0033-1353364

Journal of Neurological Surgery Part B: Skull Base, Inhaltsverzeichnis

J Neurol Surg B Skull Base 2013; 74(05): 324-330
DOI: 10.1055/s-0033-1353364

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Outcomes following Microvascular Free Tissue Transfer in Reconstructing Skull Base Defects

Jose L. Llorente

¹Department of Otorhinolaryngology, Skull Base Unit, Instituto Universitario de Oncología del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain

,

Fernando Lopez

¹Department of Otorhinolaryngology, Skull Base Unit, Instituto Universitario de Oncología del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain

,

Daniel Camporro

²Department of Plastic Surgery, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain

,

Angel Fueyo

²Department of Plastic Surgery, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain

,

Juan C. Rial

³Department of Neurosurgery, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain

,

Ramon Fernandez de Leon

³Department of Neurosurgery, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain

,

Carlos Suarez

¹Department of Otorhinolaryngology, Skull Base Unit, Instituto Universitario de Oncología del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain

› Institutsangaben

Abstract

Objective Successful resection of complex tumors involving the skull base (SB) depends on the ability to reconstruct the resulting defects. The objective of this study was to assess the outcomes of patients undergoing reconstruction after resection of SB tumors with free flaps.

Methods From 1995 to 2010 a retrospective review of cases was undertaken. Demographics, histology, surgical management, complications, locoregional control, and survival were analyzed.

Results We performed 62 flaps in 57 patients. There was a preponderance of sinonasal malignancies (45%), and most lesions involved the anterior SB (81%). A total of 94% of patients underwent radiotherapy. Reconstruction was undertaken mainly with anterolateral thigh (37%) or radial forearm (34%) flaps. Complications occurred in 17% of patients, and the flap's success rate was 94%.

Conclusion Free flaps are versatile and highly reliable for reconstructing defects resulting from resections of the SB. They should be considered for SB reconstruction of large three-dimensional defects as well as defects involving an irradiated field. Successful reconstruction of the SB can be performed using a small number of highly dependable flaps.

Keywords

skull base - head and neck reconstruction - skull base defects - free flaps - microvascular free tissue transfer

Volltext

Referenzen

References
1 Nouraei SAR, Ismail Y, Gerber CJ, Crawford PJ, McLean NR, Hodgkinson PD. Long-term outcome of skull base surgery with microvascular reconstruction for malignant disease. Plast Reconstr Surg 2006; 118 (5) 1151-1158 ; discussion 1159–1160
2 Chang DW, Langstein HN, Gupta A , et al. Reconstructive management of cranial base defects after tumor ablation. Plast Reconstr Surg 2001; 107 (6) 1346-1355 ; discussion 1356–1357
3 Neligan PC, Mulholland S, Irish J , et al. Flap selection in cranial base reconstruction. Plast Reconstr Surg 1996; 98 (7) 1159-1166 ; discussion 1167–1168
4 Irish JC, Gullane PJ, Gentili F , et al. Tumors of the skull base: outcome and survival analysis of 77 cases. Head Neck 1994; 16 (1) 3-10
5 Camporro D, Fueyo A, Llorente JL, Sánchez J, Vega C, Martín C. Reconstrucción de la zona donante del colgajo de antebrazo libre radial mediante colgajo de avance—rotación cubital. Cir Plast Iberlatinamer 2003; 29: 191-197
6 Burkey BB, Schmalbach CE, Coleman Jr JR. Microvascular flaps. In: Papel ID, , ed. Facial Plastic and Reconstructive Surgery. 3rd ed. New York, NY: Thieme Medical Publishers; 2009: 774
7 Moyer JS, Chepeha DB, Teknos TN. Contemporary skull base reconstruction. Curr Opin Otolaryngol Head Neck Surg 2004; 12 (4) 294-299
8 Trivedi NT, Kuriakose MA, Iyer S. Reconstruction in skull base surgery: review of current concepts. Indian J Plast Surg 2007; 40: 52-59
9 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
10 Yamamoto Y, Minakawa H, Kawashima K , et al. Experience with 24 cases of reconstructive anterior skull base surgery: classification and evaluation of postoperative facial appearance. Skull Base Surg 2000; 10 (2) 65-70
11 Pusic AL, Chen CM, Patel S, Cordeiro PG, Shah JP. Microvascular reconstruction of the skull base: a clinical approach to surgical defect classification and flap selection. Skull Base 2007; 17 (1) 5-15
12 Yano T, Okazaki M, Tanaka K , et al. A new concept for classifying skull base defects for reconstructive surgery. J Neurol Surg B Skull Base 2012; 73 (2) 125-131
13 Gullane PJ, Lipa JE, Novak CB, Neligan PC. Reconstruction of skull base defects. Clin Plast Surg 2005; 32 (3) 391-399 , vii
14 Ganly I, Patel SG, Singh B , et al. Complications of craniofacial resection for malignant tumors of the skull base: report of an International Collaborative Study. Head Neck 2005; 27 (6) 445-451
15 Schmalbach CE, Webb DE, Weitzel EK. Anterior skull base reconstruction: a review of current techniques. Curr Opin Otolaryngol Head Neck Surg 2010; 18 (4) 238-243
16 Georgantopoulou A, Hodgkinson PD, Gerber CJ. Cranial-base surgery: a reconstructive algorithm. Br J Plast Surg 2003; 56 (1) 10-13
17 Weber SM, Kim JH, Wax MK. Role of free tissue transfer in skull base reconstruction. Otolaryngol Head Neck Surg 2007; 136 (6) 914-919
18 Olson GT, Bayles SW. Recent innovations in the use of the radial forearm free flap. Curr Opin Otolaryngol Head Neck Surg 2001; 9: 201-204
19 Camporro D, Fueyo A, Martín C, Carnero S, Llorente JL. Use of lateral circumflex femoral artery system free flaps in skull base reconstruction. J Craniofac Surg 2011; 22 (3) 888-893
20 Chiu ES, Kraus D, Bui DT , et al. Anterior and middle cranial fossa skull base reconstruction using microvascular free tissue techniques: surgical complications and functional outcomes. Ann Plast Surg 2008; 60 (5) 514-520
21 Pryor SG, Moore EJ, Kasperbauer JL. Orbital exenteration reconstruction with rectus abdominis microvascular free flap. Laryngoscope 2005; 115 (11) 1912-1916
22 Chang DW, Robb GL. Microvascular reconstruction of the skull base. Semin Surg Oncol 2000; 19 (3) 211-217
23 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
24 Moncrieff MD, Spira K, Clark JR , et al. Free flap reconstruction for melanoma of the head and neck: indications and outcomes. J Plast Reconstr Aesthet Surg 2010; 63 (2) 205-212
25 Deschlet DG, Gutin PH, Mamelak AN , et al. Complications of anterior skull base surgery. Skull Base Surg 1996; 6: 113-118