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Swendseid et al. Plast Aesthet Res 2021;8:41 Plastic and
DOI: 10.20517/2347-9264.2021.47
Aesthetic Research

Review Open Access

Free tissue transfer for skull base reconstruction - a
review

Brian Swendseid, Mark Chaskes, Ramez Philips, Yamil Selman, Blair Barton, Howard Krein, Ryan
Heffelfinger, Adam Luginbuhl, Joseph Curry
Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA 19107, USA.
Correspondence to: Dr. Brian Swendseid, Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University
Hospitals, 925 Chestnut St, 6th Fl, Philadelphia, PA 19107, USA. E-mail: brianswendseid@gmail.com

How to cite this article: Swendseid B, Chaskes M, Philips R, Selman Y, Barton B, Krein H, Heffelfinger R, Luginbuhl A, Curry J.
Free tissue transfer for skull base reconstruction - a review. Plast Aesthet Res 2021;8:41. https://dx.doi.org/10.20517/2347-
9264.2021.47
Received: 19 May 2021 First Decision: 15 Jun 2021 Revised: 26 Jun 2021 Accepted: 1 Jul 2021 First online: 12 Jul 2021

Academic Editors: Matthew Spector, Mark K. Wax Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Evolutions in skull base surgery and reconstructive technique have given surgeons the confidence to resect and
repair increasingly advanced skull base pathologies. Free tissue transfer (FTT) provides a versatile option capable
of addressing numerous simultaneous reconstructive goals. This review highlights some of the nuances, challenges,
and considerations of performing FTT for skull base reconstruction in the anterior, central and lateral skull base.
This review combines the expert opinion of the senior authors with those of the field at large as queried through
PubMed searches regarding skull base reconstruction and FTT. Reconstructive goals include separation of
intracranial from extracranial cavities, obliteration of dead space, and protection of vascular and neural structures.
Atypical vascular pedicle management is commonly needed, especially for endonasal and central skull base
resection. Virtual surgical planning may be beneficial for complex bony reconstruction. Familiarity with common
complications such as cerebrospinal fluid leak, nasocutaneous fistula, and inferior flap displacement, as well as
associations for their development, can help plan the reconstruction to minimize morbidity.

Keywords: Skull base, reconstruction, free flap

INTRODUCTION
Decision-making surrounding the malignant and benign pathology of the skull base remains exceptionally

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
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