Reconstruction of the anterior skull base with radial forearm free tissue transfer:case series and literature review

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.

The reliability of the“Iberic graft”for covering of the radial forearm free flap donor site

Aim:Traditional donor site closure from radial forearm free flap(RFFF)has been associated with esthetic and functional morbidity.To avoid complications,such as color mismatch and secondary donor site morbidity,a new technique named‘‘Iberic graft’’for covering the RFFF donor site was described previously by our team.Methods:A study of patients who underwent reconstruction of head and neck defects using a RFFF was conducted to assess postoperative complications of the RFFF donor site and also to evaluate the morbidity in terms of aesthetics and function following the use of the“Iberic graft”.The donor site was covered by the use of a combined local triangular full-thickness skin graft.Color match,quality of the scar,presence of necrosis,dehiscence of the suture or tendon exposure were recorded and analyzed.Results:One hundred and twenty-five consecutive patients undergoing RFFF harvesting were included.RFFF donor site defects ranged from 15 cm2 to 70 cm2;9 patients(7%)had small dehiscences of the forearm skin graft,whereas 2 cases(1.6%)presented tendon exposure.Otherwise,partial skin graft loss occurred in a few patients.In all cases,these sites healed secondarily by conservative management,with no final impairment of function.Assessment of the forearm donor site at 1 to 3 months after the primary surgical procedure showed complete defect coverage,good color match,and no scarring along the graft line.Conclusion:The“Iberic graft”is a reliable method for closing most of RFFF donor site defects as it provides excellent color match and pliability,while obviates the need for a second surgical site.

A rare case of bilateral absence of distal ulnar artery

It is fairly common to find anatomic variations and anomalies in the arterial pattern of the upper extremities.However,a complete absence of the distal ulnar artery bilaterally is extremely rare.During preoperative assessment for a radial forearm free flap,we accidentally discovered bilateral distal ulnar artery agenesis.In this article,the clinical implications of this variation are discussed,along with a review of the literature.