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Flap selection in cranial base reconstruction
P C Neligan1, S Mulholland, J Irish
1Head and Neck Program, Toronto Hospital, Ontario, Canada.
Plastic and Reconstructive Surgery
|December 1, 1996
Summary
Free-flap reconstructions offer superior outcomes for skull base defects, demonstrating better wound healing and fewer complications than pedicled flaps. Microvascular free-tissue transfer is recommended for moderate to large cranial base reconstructions.
Area of Science:
- Plastic Surgery
- Neurosurgery
- Craniofacial Reconstruction
Background:
- Skull base defects pose significant reconstruction challenges.
- Traditional methods include pericranial flaps and pedicled myocutaneous flaps.
Purpose of the Study:
- To compare the efficacy of local, pedicled, and free-flap reconstructions for skull base defects.
- To identify the safest and most economical reconstruction method.
Main Methods:
- Retrospective analysis of 90 skull base defect reconstructions over 10 years.
- Comparison of outcomes between pericranial, pedicled myocutaneous, and free-flap techniques.
Main Results:
- Pericranial flaps provided reliable dural sealing.
- Free-flap reconstructions showed higher uncomplicated primary wound healing (95% vs. 62.5%).
- Free flaps had significantly lower rates of flap loss (0%), CSF leak (5%), meningitis, and abscess (0%).
Conclusions:
- Microvascular free-tissue transfer is the safest and most economical option for moderate to large composite skull base defects.
- Free-flap reconstruction offers superior outcomes compared to pedicled myocutaneous flaps.