FLAP SELECTION IN CRANIAL BASE RECONSTRUCTION

We have compared our local, pedicled, and free-flap reconstructions fo r 90 skull base defects performed over the past 10 years. The pericran ial flap was found to provide a reliable dural seal. Free-flap reconst ructions exhibited a significantly higher incidence of uncomplicated p rimary wound healing (95 versus 62.5 percent) and a much lower inciden ce of flap loss (0 percent), cerebrospinal fluid leak (5 percent), men ingitis, and abscess (0 percent) when compared. With defects reconstru cted with pedicled myocutaneous naps. We conclude that microvascular f ree-tissue transfer is the safest, most economical procedure when face d with moderate to large composite defects of the cranial base.