Esthetic Craniofacial Bony and Skull Base Reconstruction Using Flap Wrapping Technique

Area of Science:

• Plastic Surgery
• Craniofacial Surgery
• Oncologic Reconstruction

Background:

• Skull base reconstruction and craniofacial bone defect repair present challenges in achieving both safety and aesthetic outcomes.
• Preoperative treatments like proton beam therapy can further complicate surgical reconstruction due to tissue changes.

Observation:

• A novel flap wrapping technique was developed, utilizing the vastus lateralis muscle of an anterolateral thigh (ALT) free flap for skull base defect filling.
• Structural craniofacial bony reconstruction was performed using autologous calvarial bone grafts.
• The core innovation involves completely wrapping the autologous bone graft with the vascularized fascia of the ALT free flap.

Findings:

• In two patients with anterior skull base tumors and craniofacial defects, this technique successfully reconstructed the area.
• Postoperatively, neither patient experienced intracranial infection or exposed bone grafts, despite prior proton beam therapy.
• The vascularized fascia wrapping provided natural contouring and prevented craniofacial collapse, enhancing facial appearance.

Implications:

• The flap wrapping technique offers a safe and effective solution for complex skull base and craniofacial reconstructions.
• This method addresses the critical need for protecting bone grafts in irradiated or compromised tissue beds.
• Improved aesthetic results and reduced complications suggest broader applicability in reconstructive surgery.