Secure flap fixation to bony tissue using an anchoring system in skull-base surgery

The reconstruction of extensive skull-base defects using flap transfer decreases crucial postoperative complications. However, flap fixation to bony tissue is often difficult, especially if there is no soft tissue to pass sutures through, and unsteady flap fixation causes dead space formation or displacement of the transferred flap due to gravity. The authors used an anchoring system for secure flap fixation in seven cases with difficult flap fixation, using the conventional suturing technique. Anchors were inserted at strategic points in the bony tissue, and secure flap fixation was achieved in all cases. Postoperative CT scans showed no dead space formation, and major postoperative complications were not observed. The anchoring system can be buried in bony tissue with a thickness of more than 4 mm, and it enables reliable flap fixation and dead space obliteration. Although the cost is relatively high, the procedure is simple and lowers the risk of crucial postoperative complications in skull-base surgery.