FREE LATISSIMUS-DORSI FLAP FOR RECONSTRUCTION OF THE ANTERIOR BASE OFTHE SKULL

Defects resulting after resection of malignant tumors of the paranasal sinuses ii involving the anterior base of the skull need an adequate closure. In addition to such avital tissue as fascia lata, fat,or cera mics, in recent years we used free muscle flaps from the latissimus do rsi for reconstruction. We performed this reconstructive method in sev en patients after radical tumor resection. The operation was performed in cooperation with the neurosurgeon. In three cases a transfrontal i n combination with a transfacial approach was used and in four cases o nly a transfacial approach was chosen. The flap was tailored as a pure muscle transplant if only the base of the skull had to be repaired an d the surgical cavity had to be obliterated. In three cases a skin pad dle was left on the muscle to perform a closure of the orbit and the h ard palate. In four patients we performed primary reconstruction, in t hree cases secondary reconstruction, which was necessary because cereb rospinal fluid (CSI;) leakage occurred after primary reconstruction wi th avital tissue in addition to insufficient pericranial flap. None of the patients with primary reconstruction developed CSF leakage. There was no free flap failure. The aim of this reconstruction is a safe cl osure of skull base defects to prevent infection, meningitis, brain ab scess, and brain herniation.