Related Experiment Video
Updated: Jan 3, 2026
10:36
Vascularized Composite Hand Allograft Procurement and Preparation for Distal and Proximal Forearm Allotransplantation: A Stepwise Approach
Published on: May 23, 2025
701
Radial Forearm Free Tissue Transfer to Clival Defect
Jennifer D Moy1, Paul A Gardner2,3, Shaum Sridharan1
1Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States.
Journal of Neurological Surgery. Part B, Skull Base
|November 22, 2019
Summary
Reconstructing complex skull base defects after surgery is difficult. A radial forearm free flap (RFFF) successfully repaired a persistent cerebrospinal fluid leak in the craniocervical junction (CCJ) using a transmaxillary approach.
Area of Science:
- Neurosurgery
- Otolaryngology
- Plastic Surgery
Background:
- Craniocervical junction (CCJ) reconstruction after endoscopic endonasal skull base surgery (ESBS) presents significant challenges.
- Microvascular free tissue transfer, while common in open surgery, is rarely used in ESBS for CCJ defects.
Purpose of the Study:
- To describe the successful use of a radial forearm free flap (RFFF) for reconstructing a challenging CCJ defect.
- To detail the transmaxillary approach for inseting the RFFF in a patient with a clival chordoma resection defect.
Main Methods:
- A 54-year-old female with a persistent cerebrospinal fluid (CSF) leak and skull base defect at the CCJ underwent reconstruction.
- A radial forearm free flap (RFFF) was utilized, accessed via a transmaxillary approach with maxillotomies.
- Flap inset involved endonasal and transoral suturing; vascularization was confirmed with ICG angiography and CT/MRI angiography.
Main Results:
- The RFFF provided adequate coverage for the central and posterior fossa skull base defect.
- The transmaxillary approach facilitated successful insetion and vascular pedicle passage.
- Postoperative imaging confirmed successful flap vascularization and cessation of CSF leak.
Conclusions:
- Radial forearm free flap (RFFF) inset via a transmaxillary approach is a viable option for complex CCJ defects after ESBS.
- This technique offers sufficient reconstructive surface and pedicle length for challenging skull base reconstructions.
- Successful reconstruction addresses persistent CSF leaks and provides durable closure.
