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. 2017 Oct;78(5):393-398.
doi: 10.1055/s-0037-1602245. Epub 2017 May 8.

Fascia Lata Free Flap Anastomosed to the Superior Trochlear System for Reconstruction of the Anterior Skull Base

Camilo Reyes  1 , C Arturo Solares  2 , Michael A Fritz  3 , Michael Groves  1 , Heather Bentley  1
Affiliations

Fascia Lata Free Flap Anastomosed to the Superior Trochlear System for Reconstruction of the Anterior Skull Base

Camilo Reyes et al. J Neurol Surg B Skull Base. 2017 Oct.

Abstract

Objectives This study aims to introduce a novel technique for the reconstruction of the anterior skull base using a free vascularized anterolateral thigh fascia lata free flap (FLFF) anastomosed to the superior trochlear artery (STA). Methods The diameter of the STA was measured in 38 (76 sides) computed tomography angiographies (CTAs). Independently, six cadaver heads were used to measure the diameter of the supratrochlear system, and the model was applied to one of them. Results In women, the average diameter of the STA was 2.5 and 2.8 mm 2 for the right and left sides, respectively; for men, it was 3.0 and 3.2 mm 2 , respectively. In cadavers, the average diameter of both STA was 2.5 mm 2 . There was no statistical difference when comparing the right and left STA diameters between the CTA from women and men ( p < 0.208 and < 0.492, respectively). An FLFF advanced through the nose was anastomosed to the STA to reconstruct the anterior skull base. Conclusion The STA is a constant vessel with a 2.5 to 3.0 mm 2 diameter in men and women that can be used as a recipient free flap vessel. The FLFF can cover the entire skull base. This is a novel method to reconstruct the anterior skull base when local flaps are not available.

Keywords: anterior skull base; anterolateral thigh fascia lata; free flap; the superior trochlear system.

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Figures

Fig. 1
Fig. 1
A cadaver left leg was used for the fascia lata free flap harvest. White arrow shows the flap and the white line shows its pedicle.
Fig. 2
Fig. 2
( A ) 3D rendering of a patient CTA scan, white arrow indicates the course of the left STA, white circle marks the area of the osteotomy. ( B ) Left Lynch incision exposing the superior trochlear artery and vein, black and white arrows respectively.
Fig. 3
Fig. 3
The FLFF was successfully advanced through the cadavers left nostril without any damage to the flap or its pedicle. FLFF, fascia lata free flap.
Fig. 4
Fig. 4
( A ) Endoscopic exposure of the anterior skull base. The cribriform plate, falx cerebri, and olfactory bulbs were removed. The sella, bilateral internal carotid artery, and clivus were also exposed. ( B ) Flap insert, half of the defect in the sagittal plane is covered. ( C ) FLFF covered the entire skull base defect successfully; white arrow shows the FLFF pedicle. ( D ) FLFF insert and its pedicle exiting the previously made osteotomy, the tension was applied to the pedicle for picture purposes. F, frontal sinus; FLFF, fascia lata free flap; RO, right orbit; LO, left orbit; ICA, internal carotid artery; S, sella.
Fig. 5
Fig. 5
A silk suture was tied to the flaps pedicle and was used to exteriorize it through the osteotomy. The superior trochlear artery and vein were used as recipient vessels, black and white arrows respectively.
Fig. 6
Fig. 6
( A ) Exposed FLFF lateral femoral circumflex artery (black arrow) and recipient superior trochlear artery (white arrow). ( B ) Anastomosis between the lateral femoral circumflex arteries (black arrow) with the superior trochlear artery (white arrow).
See this image and copyright information in PMC

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