Free Flap Reconstructive Options for Anterior SB Defects

Background: Anterior skull base (SB) defects are complex SB defects that require significant expertise in reconstruction. Objective: To understand reconstruction of anterior SB. Design: Single-institution retrospective review. Methods: Patients who underwent free flap reconstruction for anterior SB defects were evaluated at a single institution from 2012 to 2024. Flap type and complications were recorded as were surgical approaches. Results: 63 free flap reconstructions were identified. Most common approaches consisted of open maxillectomy and craniofacial resections. A total of 84% reconstructions were done with anterolateral thigh (ALT) flaps, of which 70% were chimeric. Overall, 33% of patients had complications, with a 22% reoperation rate and 1 flap death. Facial artery and vein were most common vessels followed by superficial temporal vessels. Conclusions: Chimeric flaps are excellent for anterior SB defects and aid in flexibility of inset. Reviewer's Comments: These defects ca more...