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Refinements using free-tissue transfer for complex cranial base reconstruction

R Izquierdo1, J P Leonetti, T C Origitano

  • 1Department of Surgery, Loyola University of Chicago Stritch School of Medicine, Ill.

Plastic and Reconstructive Surgery
|September 1, 1993
PubMed
Summary
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The rectus abdominis free flap is a reliable option for closing large skull base defects after tumor resection. This versatile flap ensures successful reconstruction and minimizes complications like cerebrospinal fluid leaks.

Area of Science:

  • Neurosurgery
  • Plastic Surgery
  • Surgical Oncology

Background:

  • Large skull base defects following tumor resection pose reconstruction challenges.
  • Local tissue closure is often insufficient for massive extirpation defects.

Purpose of the Study:

  • To evaluate the efficacy of rectus abdominis free flaps for closing basicranial defects.
  • To assess the outcomes and complications associated with different types of rectus abdominis flaps.

Main Methods:

  • Retrospective review of 19 consecutive patients undergoing basicranial defect closure.
  • Utilized rectus abdominis muscle flaps, myocutaneous rectus abdominis flaps, and deepithelialized rectus abdominis muscle flaps.
  • All flaps were sourced from the deep inferior epigastric vascular territory.

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Main Results:

  • All 18 rectus abdominis free flaps survived, successfully sealing the intracranial space in most patients.
  • One patient experienced a cerebrospinal fluid leak, potentially avoidable with a deepithelialized flap.
  • Minor complications included wound infections, a contained subdural abscess, and a donor-site hernia. No meningitis occurred.

Conclusions:

  • The rectus abdominis free flap is a robust and adaptable option for skull base reconstruction.
  • Deepithelialized myocutaneous flaps may offer advantages in obliterating dead space and preventing cerebrospinal fluid leaks.
  • Understanding the vascular anatomy of the deep inferior epigastric vessels is crucial for successful three-dimensional reconstruction.