Successful reconstruction of irradiated anterior skull base defect using the dual flap technique involving local pericranial flap and radial forearm free flap.

Abstract

Skull base reconstruction presents a challenging therapeutic problem requiring a

multispecialty surgical approach and close cooperation between the neurosurgeon,

head and neck surgeon, as well as plastic and reconstructive surgeon during all

stages of treatment. The principal goal of skull base reconstruction is to

separate the intracranial space from the nasopharyngeal and oropharyngeal

cavities, creating support for the brain and providing a water-tight barrier

against cerebrospinal fluid leakage and ascending infection. We present a case

involving a 58-year-old man with anterior skull base defects (2.5 cm x 3 cm)

secondary to the removal of olfactory neuroblastoma. The patient received

conventional radiation therapy at 6000 cGy in 30 fractions approximately a month

before tumor removal. The patient had radiation therapy before surgery and was

planned to have postoperative radiation therapy, which would lead to a higher

complication rate of reconstruction. Artificial dura was used for the packing of

the dural defect, which was also suspected to increase the complication rate of

reconstruction. For these reasons, we chose to apply the dual flap technique,

which uses both local pericranial flap and de-epithelized radial forearm free

flap for anterior skull base defect to promote wound healing. During 28 months of

follow-up after coverage of the anterior skull base defect, the dual flap

survived completely, as confirmed through follow-up magnetic resonance imaging.

The patient was free of cerebrospinal fluid leakage, meningitis, and abscess, and

there was minimal donor-site morbidity of the radial forearm free flap.

Reconstruction of anterior skull base defects using the dual flap technique is

safe, reliable, and associated with low morbidity, and it is ideal for irradiated

wounds and low-volume defects.