Biomaterial Database

Pedicled flaps in endoscopic skull base reconstruction: review of current techniques. 2015

Matthew J Clavenna, and Justin H Turner, and Rakesh K Chandra

Vanderbilt Department of Otolaryngology, Bill Wilkerson Center, Nashville, Tennessee, USA.

OBJECTIVE To discuss the current applications and indications for the use of pedicled flaps in the reconstruction of endoscopic skull base defects. RESULTS Current trends in endoscopic skull base surgery include the use of vascularized pedicled flaps rather than free tissue grafts (autograft or allograft) for the repair of anterior cranial base defects. In particular, recent evidence-based algorithms for skull base reconstruction suggest that use of pedicled flaps for clival defects and high-flow cerebrospinal fluid (CSF) leaks may reduce the incidence of postoperative CSF leaks. The primary workhorse continues to be the nasoseptal flap (NSF); however, other options exist in cases wherein this flap is unavailable because of prior sacrifice or unable to reach the area of interest (e.g., defects adjacent to the frontal recess). CONCLUSIONS Adoption of vascularized pedicled flaps over the last decade, particularly the recently popularized NSF, has greatly reduced complications associated with endoscopic skull base surgery. The need for vascularized flap reconstruction is governed primarily by defect size and location, and by the presence of a high-flow CSF leak. Additional vascularized flaps can be used in conjunction with the NSF, or as an alternative when the NSF is unfavorable or unavailable.

UI	MeSH Term	Description	Entries
D011183	Postoperative Complications	Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery.	Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D004724	Endoscopy	Procedures of applying ENDOSCOPES for disease diagnosis and treatment. Endoscopy involves passing an optical instrument through a small incision in the skin i.e., percutaneous; or through a natural orifice and along natural body pathways such as the digestive tract; and/or through an incision in the wall of a tubular structure or organ, i.e. transluminal, to examine or perform surgery on the interior parts of the body.	Endoscopic Surgical Procedures,Surgical Procedures, Endoscopic,Endoscopic Surgical Procedure,Endoscopy, Surgical,Surgical Endoscopy,Surgical Procedure, Endoscopic,Procedure, Endoscopic Surgical,Procedures, Endoscopic Surgical
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013524	Surgical Flaps	Tongues of skin and subcutaneous tissue, sometimes including muscle, cut away from the underlying parts but often still attached at one end. They retain their own microvasculature which is also transferred to the new site. They are often used in plastic surgery for filling a defect in a neighboring region.	Island Flap,Island Flaps,Flap, Surgical,Flaps, Surgical,Pedicled Flap,Surgical Flap,Flap, Island,Flap, Pedicled,Flaps, Island,Flaps, Pedicled,Pedicled Flaps
D019291	Skull Base	The inferior region of the skull consisting of an internal (cerebral), and an external (basilar) surface.	Basicranium,Cranial Base,Base of Skull,Basis cranii,Base, Cranial,Base, Skull
D019651	Plastic Surgery Procedures	Procedures used to reconstruct, restore, or improve defective, damaged, or missing structures.	Cosmetic Reconstructive Surgical Procedures,Cosmetic Surgical Procedures,Esthetic Reconstructive Surgical Procedures,Esthetic Surgical Procedures,Plastic Surgical Procedures,Reconstructive Surgical Procedures,Reconstructive Surgical Procedures, Cosmetic,Cosmetic Reconstructive Surgery,Procedure, Reconstructive Surgical,Procedures, Reconstructive Surgical,Reconstructive Surgical Procedure,Reconstructive Surgical Procedures, Esthetic,Surgical Procedure, Reconstructive,Surgical Procedures, Reconstructive,Cosmetic Reconstructive Surgeries,Cosmetic Surgical Procedure,Esthetic Surgical Procedure,Plastic Surgery Procedure,Plastic Surgical Procedure,Procedure, Cosmetic Surgical,Procedure, Esthetic Surgical,Procedure, Plastic Surgery,Procedure, Plastic Surgical,Procedures, Cosmetic Surgical,Procedures, Esthetic Surgical,Procedures, Plastic Surgery,Procedures, Plastic Surgical,Reconstructive Surgeries, Cosmetic,Reconstructive Surgery, Cosmetic,Surgeries, Cosmetic Reconstructive,Surgery Procedure, Plastic,Surgery Procedures, Plastic,Surgery, Cosmetic Reconstructive,Surgical Procedure, Cosmetic,Surgical Procedure, Esthetic,Surgical Procedure, Plastic,Surgical Procedures, Cosmetic,Surgical Procedures, Esthetic,Surgical Procedures, Plastic
D065634	Cerebrospinal Fluid Leak	Discharge of cerebrospinal fluid through a hole through the skull bone most commonly draining from the nose (CEREBROSPINAL FLUID RHINORRHEA) or the ear (CEREBROSPINAL FLUID OTORRHEA).	Cerebrospinal Fluid Drainage,Cerebrospinal Fluid Drainage, Post-Traumatic,Cerebrospinal Fluid Drainage, Spontaneous,Cerebrospinal Fluid Drainage, Traumatic,Cerebrospinal Fluid Leak, Post-Traumatic,Cerebrospinal Fluid Leak, Spontaneous,Cerebrospinal Fluid Leak, Traumatic,Cerebrospinal Fluid Leakage,Cerebrospinal Fluid Leakage, Post-Traumatic,Cerebrospinal Fluid Leakage, Spontaneous,Cerebrospinal Fluid Leakage, Traumatic,Spinal Cerebrospinal Fluid Leak,Spinal Cerebrospinal Fluid Leak, Post-Traumatic,Spinal Cerebrospinal Fluid Leak, Spontaneous,Spinal Cerebrospinal Fluid Leak, Traumatic,Cerebrospinal Fluid Drainage, Post Traumatic,Cerebrospinal Fluid Drainages,Cerebrospinal Fluid Leak, Post Traumatic,Cerebrospinal Fluid Leakage, Post Traumatic,Cerebrospinal Fluid Leakages,Cerebrospinal Fluid Leaks,Drainage, Cerebrospinal Fluid,Drainages, Cerebrospinal Fluid,Fluid Drainage, Cerebrospinal,Fluid Drainages, Cerebrospinal,Fluid Leak, Cerebrospinal,Fluid Leakage, Cerebrospinal,Fluid Leakages, Cerebrospinal,Fluid Leaks, Cerebrospinal,Leak, Cerebrospinal Fluid,Leakage, Cerebrospinal Fluid,Leakages, Cerebrospinal Fluid,Leaks, Cerebrospinal Fluid,Spinal Cerebrospinal Fluid Leak, Post Traumatic