Classification and Microvascular Flap Selection for Anterior Cranial Fossa Reconstruction

Journal of Reconstructive Microsurgery
James D VargoBrian T Andrews

Abstract

Microvascular reconstruction of the anterior cranial fossa (ACF) creates difficult challenges. Reconstructive goals and flap selection vary based on the defect location within the ACF. This study evaluates the feasibility and reliability of free tissue transfer for salvage reconstruction of low, middle, and high ACF defects. A retrospective review was performed. Reconstructions were anatomically classified as low (anterior skull base), middle (frontal bar/sinus), and high (frontal bone/soft tissue). Subjects were evaluated based on pathologic indication and goal, type of flap used, and complications observed. Eleven flaps in 10 subjects were identified and anatomic sites included: low (n = 5), middle (n = 3), and high (n = 3). Eight of 11 reconstructions utilized osteocutaneous flaps including the osteocutaneous radial forearm free flap (OCRFFF) (n = 7) and fibula (n = 1). Other reconstructions included a split calvarial graft wrapped within a temporoparietal fascia free flap (n = 1), latissimus myocutaneous flap (n = 1), and rectus abdominis myofascial flap (n = 1). All 11 flaps were successful without microvascular compromise. No complications were observed in the high and middle ACF defect groups. Two of five flaps in the lo...Continue Reading

Citations

Aug 29, 2019·Current Opinion in Otolaryngology & Head and Neck Surgery·Liliana EinElizabeth A Nicolli
Apr 22, 2021·The Annals of Otology, Rhinology, and Laryngology·Heather M MinchewBrian T Andrews
May 14, 2021·Korean Journal of Neurotrauma·Hieder Al-ShamiAhmed M Salah

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