Salvage skull base reconstruction in the endoscopic era: Vastus lateralis free tissue transfer.

Abstract

When locoregional flaps fail to reconstruct the skull base, the microvascular surgeon faces several reconstructive challenges. We present our technique and results of salvage anterior skull base reconstruction utilizing the vastus lateralis free tissue transfer (VLFTT). Four patients with anterior skull base defects after previous locoregional flap failure underwent free tissue transfer reconstruction with VLFTT. The success rate of free tissue transfer was 100%. Complete separation of the intracranial and sinonasal cavities was achieved in all patients; thus, resolving the cerebrospinal fluid (CSF) leakage in all patients. The VLFTT was inset through a minimally invasive approach utilizing an anterior maxillotomy via a gingivobuccal incision, an endoscopic medial maxillectomy, and endoscopic inset in all patients. No vein grafts were needed. This technique permits endoscopic endonasal inset and placement of reliable, well vascularized free tissue that may be utilized for complex, secondary reconstruction of the skull base.