Surgical anatomy and utility of pedicled vascularized tissue flaps for multilayered repair of skull base defects.
Sam Safavi-Abbasi, Noritaka Komune, Jacob B Archer, Hai Sun, Nicholas Theodore, Jeffrey James, Andrew S Little, Peter Nakaji, Michael E Sughrue, Albert L Rhoton, Robert F Spetzler
Author Information
Sam Safavi-Abbasi: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Noritaka Komune: Department of Neurological Surgery, University of Florida, Gainesville, Florida, and.
Jacob B Archer: Department of Oral and Maxillofacial Surgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma.
Hai Sun: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Nicholas Theodore: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Jeffrey James: Department of Oral and Maxillofacial Surgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma.
Andrew S Little: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Peter Nakaji: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Michael E Sughrue: Department of Oral and Maxillofacial Surgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma.
Albert L Rhoton: Department of Neurological Surgery, University of Florida, Gainesville, Florida, and.
Robert F Spetzler: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
OBJECT The objective of this study was to describe the surgical anatomy and technical nuances of various vascularized tissue flaps. METHODS The surgical anatomy of various tissue flaps and their vascular pedicles was studied in 5 colored silicone-injected anatomical specimens. Medical records were reviewed of 11 consecutive patients who underwent repair of extensive skull base defects with a combination of various vascularized flaps. RESULTS The supraorbital, supratrochlear, superficial temporal, greater auricular, and occipital arteries contribute to the vascular supply of the pericranium. The pericranial flap can be designed based on an axial blood supply. Laterally, various flaps are supplied by the deep or superficial temporal arteries. The nasoseptal flap is a vascular pedicled flap based on the nasoseptal artery. Patients with extensive skull base defects can undergo effective repair with dual flaps or triple flaps using these pedicled vascularized flaps. CONCLUSIONS Multiple pedicled flaps are available for reconstitution of the skull base. Knowledge of the surgical anatomy of these flaps is crucial for the skull base surgeon. These vascularized tissue flaps can be used effectively as single or combination flaps. Multilayered closure of cranial base defects with vascularized tissue can be used safely and may lead to excellent repair outcomes.
