Reconstruction of operative defects of the posterolateral cranial base

Abstract

Closure of defects after resection of tumors of the posterolateral skull base presents a unique challenge to the skull base surgical team. Although most defects can be closed primarily over free fat grafts, complex techniques may be required. The use of flaps for reconstruction of ablative defects following resection of tumors of the posterolateral skull base requires a thorough understanding of the layered anatomy of the scalp, its vascular supply, and principles of flap selection and management. Although a variety of flaps are available to the reconstructive surgeon, familiarity with a few reliable flaps is preferable. Three methods of closure will be described: (1) occipital galeal flap; (2) extended trapezius myocutaneous flap; and (3) lower serratus muscle microvascular free flap. Each technique is chosen based on the tissue requirements of the surgical defect. Factors such as size, presence of radiation, and exposure of vital structures are considered before flap selection.