A New Vascularized Flap for Cranial Base Reconstruction: The Posterior Septal Nasal Floor Mucosal Flap

Abstract

Objective: While pedicled intranasal flaps, such as the nasoseptal flap (NSF) successfully reduce postoperative CSF leaks following endoscopic endonasal approaches (EEA) to the skull base, local morbidity arising from denuded area donor site can impact quality of life. Given success with the nasal floor free mucosal graft (FMG) in place of the NSF, there is a question of whether the mucosal floor could undergo transformation into a pedicled flap, harnessing the robust blood supply of the posterior septal artery (PSA) while avoiding the morbidity that comes with the traditional NSF. This study describes the first anatomical description of the posterior septal nasal floor mucosal flap (PSNF) in a cadaver dissection and our experience in the first series of recipient patients for reconstruction of a sellar or suprasellar defect.