Use of Rescue Flaps in the Reconstruction of Anterior Skull Base Defects

Several traumatic and non-traumatic defects in the anterior base of the skull require incessant reconstruction to stop the leakage of cerebrospinal fluid (CSF). Reconstruction of these defects at the earliest is essential to achieve an uncomplicated recovery. Various innovations in surgical procedures are seen contemporarily in reconstructing the weaknesses in the anterior part of the skull base. Multilayer grafting techniques successfully repair minor dural defects, while significant dural defects require pedicled vascularized grafts for reconstruction. Using nasoseptal flaps (NSFs) has drastically lowered the instances of CSF leaks in significant dural defects. The rescue flap is an advancement in the approach of the NSF, which was discovered in 2011. This flap is made in a downward direction with the formation of a posterior superior incision so that it does not interfere with the mucosal flap. A small incision is made at the ostium of the sphenoid bone, which is brought into the anterior aspect of the superior nasal septum. The mucosa is elevated inferiorly through the ostium of the sphenoid bone, so some septal branch of the sphenopalatine artery is preserved. In this way, the vascular supply is protected. However, in cases of CSF leak during operations, this rescue flap is reverted into an atypical and standard NSF for reconstructing the base of the skull. This rescue flap technique gives a binaural approach to sella in a way that does not compromise the pedicle during tumor removal. This rescue flap significantly decreases the duration of care in the post-operative phase and improves the cost efficiency of the surgery by avoiding donor site morbidity.