Efficacy of temporal musculopericranial flap for reconstruction of the anterior base of the skull

Since March 1988 the temporal musculopericranial (TMP) flap has been used a s our flap of choice to reconstruct defects of the anterior base of the sku ll that are larger than 2 x 3 cm, including the dura mater, in 33 patients. The primary diseases were malignant head and neck tumours (n = 16), trauma (n = 15), meningioma (n = 1), and teratoma (n = 1). The dura mater was rec onstructed with a unilateral TMP flap, after which the cranial and nasal ca vities were closed with the opposite TMP flap. In addition, bone was grafte d by sandwiching the bone between the two flaps and fixing it to the surrou nding residual bone. When a large area was resected, making it impossible t o use a TMP flap, a frontal musculopericranial (FMP) flap or a free flap (u sually the rectus abdominis myocutaneous flap) was used to close the crania l and nasal cavities-Thirty of the 33 patients recovered with no postoperat ive complications. Two patients developed extradural abscesses in the anter ior base of the skull and one developed mild meningitis, but they were succ essfully treated conservatively. When bilateral TMP flaps were used for the reconstruction, no patient had aesthetic problems in the forehead region. The TMP flap is extremely effective for the reconstruction of the anterior base of the skull because it is minimally invasive and causes few aesthetic problems in the forehead region.