Use of the radial forearm microvascular free-flap graft for cranial base reconstruction

Object. Reconstruction of thr: cranial base after resection of complex lesi ons requires creation of both a vascularized barrier to cerebrospinal fluid (CSF) leakage and tailored filling of operative defects. The authors descr ibe the use of radial forearm microvascular free-flap grafts to reconstruct skull base lesions, to fill small tissue defects, and to provide an excell ent barrier against CSF leakage. Methods. Ten patients underwent 11 skull base procedures including placemen t of microvascular free-flap grafts harvested from the forearm and featurin g the radial artery and its accompanying venae comitantes. Operations inclu ded six craniofacial, three lateral skull base, and two transoral procedure s for various diseases. Excellent results were obtained, with no persistent CSF leaks, no flap failures, and no operative infections. One temporary CS F leak was easily repaired with flap repositioning, and at one flap donor s ite minor wound breakdown was observed. One patient underwent a second proc edure for tumor recurrence and CSF leakage at a site distant from the origi nal operation. Conclusions. Microvascular free tissue transfer reconstruction of skull bas e defects by using the radial forearm flap provides a safe, reliable, low-m orbidity method for reconstructing the skull base and is ideally suited to "low-volume" defects.