Pectoralis major myocutaneous reconstruction of the anterior skull base

It was once believed that prognosis for many patients with neoplasms of the anterior skull base was hopeless. Now, however, craniofacial resection of these lesions has been curative for many patients. Massive resections of the anterior skull base pose many potentially life-threatening complications. Cerebrospinal fluid leakage with meningitis is especially troublesome when previous radiation therapy compromises wound healing. In such circumstances local tissue flaps and skin grafting may not provide reliable separation of the brain from the nose. The pectoralis major flap was utilized in eight patients undergoing anterolateral resection of the skull base. Several major advantages of this technique include: 1. reliable closure of the subarachnoid space; 2. acceptable cosmesis; 3. rapid wound rehabilitation, allowing early postoperative radiation therapy when necessary.