Reconstruction of lateral skull base oncological defects: The role of freetissue transfer

Surgical ablation for oncological disease of the lateral skull base can res ult in extensive defects, with exposed bone and dura. Inadequate coverage c an result in meningitis, osteomyelitis, or delay in adjuvant therapy. Succe ssful reconstruction requires well-vascularized soft tissue and often a lar ge cutaneous component. This study evaluates the role of free tissue transf er in reconstruction of lateral skull base detects. This study is a retrosp ective review of all patients undergoing lateral skull base resection for o ncological disease and immediate reconstruction from 1993 through 1997. The re were 18 patients with a mean age of 57 years. The temporal bone was rese cted in 50% of patients. All defects were reconstructed with free tissue tr ansfers from the following donor sites: rectus abdominis (N = 14), latissim us dorsi (N = 2), anterolateral thigh (N = 1), and lateral arm (N = 1). A c utaneous skin island was employed in all patients. Free flap survival was 1 00%. Flap-related complications occurred in 33% of patients but did not del ay the onset of adjuvant therapy. Vein grafts were not required to lengthen the vascular pedicle. Two patients required split-thickness skin grafts be cause of inadequate size of the skin island. Four patients underwent flap r evision for contour deformity a mean of 4 months postoperatively. Free tiss ue transfer is a highly reliable method of reconstructing lateral skull bas e defects in a single-stage. Careful flap selection and design can minimize the need for skin and vein grafts. The rectus abdominis donor site is pref erred because of its location, large skin island, and excellent vascular pe dicle.