Endoscopic Pericranial Flap Harvesting: Does Frontal Incision Orientation Matter? A Cadaveric Study

The pericranial flap is a useful reconstructive option in endoscopic anterior skull base surgery, particularly when the nasoseptal flap is unavailable. Minimally invasive flap harvesting requires a frontal incision that should optimize both surgical exposure and aesthetic outcome. However, the influence of incision orientation (horizontal or vertical) on the final dimensions of the flap has not been systematically evaluated. The aim of this study was to assess endoscopic flap harvesting and compare the impact of both incision orientations on flap dimensions in a fresh cadaveric model.

Dissections were performed on six fresh human cadaveric head specimens (4 males and 2 females), assigned to two groups: horizontal frontal incision (n = 3) and vertical frontal incision (n = 3). In all cases, a suprabrow suprapericranial dissection was performed under endoscopic visualization, elevating an inferiorly based pericranial flap. Craniocaudal flap length and maximum flap width were recorded. Comparisons between groups were performed using the Mann-Whitney U test.

The mean flap length was 98.3 mm in the horizontal group and 105 mm in the vertical group. The mean flap width was 71 mm in the horizontal group and 77 mm in the vertical group. No statistically significant differences were identified in either length (p = 0.164) or width (p = 0.700) between the two incision orientations. The suprabrow dissection consistently preserved the supratrochlear and supraorbital neurovascular pedicles.

Both incision orientations allow harvesting of pericranial flaps with comparable dimensions and are potentially suitable for anterior skull base reconstruction. The choice of incision orientation should be individualized according to aesthetic considerations and natural skin tension lines, as the final flap dimensions depend primarily on the extent of deep dissection and preservation of the vascular pedicle.