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Original Article Plastic and Aesthetic Research

Reconstruction of the anterior skull base

with radial forearm free tissue transfer: case

series and literature review

Windy A. Olaya, Lauren T. Daly, Emily G. Clark, Thomas Scholz, Vincent Laurence,
Keyianoosh Z. Paydar, Garrett A. Wirth, Gregory R. D. Evans

Aesthetic and Plastic Surgery Institute, University of California Irvine, Orange, CA 92868, USA.
Address for correspondence: Dr. Windy A. Olaya, Aesthetic and Plastic Surgery Institute, University of California Irvine, 200 South
Manchester, Suite 650, Orange, CA 92868, USA. E-mail: wolaya@uci.edu

ABSTRACT
Aim: Reconstruction of the anterior skull base offers an especially complex challenge as the impermeable
separation of the dural space and the upper aerodigestive tract must be maintained. We propose the
use of the radial forearm free flaps (RFFF) as a superb method of re-establishing integrity in anterior
skull base defects. Methods: Literature review and retrospective analysis of 4 single-institution
cases of anterior skull base defects reconstructed with a RFFF. Data were collected on successful and
unsuccessful defect repairs, complication rates, and length of hospitalization. Results: The indications
for surgery were pneumocephalus, recurrent brain abscesses, recurrent frontal sinus mucoceles, and
cerebrospinal fluid leak. Of the 4 cases, 1 was complicated by a small dehiscence of the craniotomy
site, 1 developed infection, and 2 required further surgery. Conclusion: The use of RFFF is an excellent
option for reconstruction of defects in the anterior skull base, especially those complicated by radiation,
prior surgery, or infections. Patients with skull base defects are inherently at high risk for post-surgical
complications. The RFFF transfers healthy, viable, well-vascularized tissue to prevent further infections
and provides a reliable barrier between the dural and sinonasal spaces. This can reduce the need for
repeat neurosurgical operations and hospitalizations.

Key words:
Aterior skull base; defect; reconstruction; plastic surgery; free flap; radial forearm free flap

INTRODUCTION infections. [1-4] Patients with these defects are generally quite
ill with poor nutritional status and a weakened immune
The use of free tissue transfer for reconstructing the system. They are at risk for multiple life-threatening
anterior skull base has become a well-established treatment conditions including meningitis, encephalitis, brain abscess,
for the rehabilitation of patients with life-threatening and persistent cerebrospinal fluid (CSF) leak, pneumocephalus,
disfiguring defects resulting from craniofacial resections. and even herniation of brain tissue. [1-3] Thus it is paramount
Defects of the anterior skull base are intrinsically complex that reconstruction of anterior skull base defects be
with an irregular serrated surface separating the dura from
the sinonasal space, and are often complicated further by
radiation, multiple prior surgical interventions, and repeat This is an open access article distributed under the terms of the Creative Commons
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Quick Response Code: For reprints contact: service@oaepublish.com
Website: How to cite this article: Olaya WA, Daly LT, Clark EG, Scholz T,
www.parjournal.net
Laurence V, Paydar KZ, Wirth GA, Evans GRD. Reconstruction of
the anterior skull base with radial forearm free tissue transfer: case
DOI: series and literature review. Plast Aesthet Res 2016;3:47-51.
10.20517/2347-9264.2015.70
Received: 18-06-2015; Accepted: 04-12-2015
© 2016 Plastic and Aesthetic Research | Published by OAE Publishing Inc. 47