Use of microvascular free-tissue transfer following ablative surgery of the skull base.

The purpose of this study was to validate the use of free flaps in reconstruction of skullbase defects after extensive resection of advanced tumors, and to justify microvascular reconstruction to improve the quality of life and survival in this population. The treatment outcome after ablative resection of skullbase tumors with free flap reconstruction over a 7-year period (1988 to 1995) was studied. Complete removal of the tumor was originally attempted in all patients. All cases had immediate reconstruction. Criteria for reconstruction with free flaps were based on extensive defects in which local flaps were insufficient. Twenty patients were identified male:female, 11:9). The most common tumor was sarcoma, followed by squamous-cell carcinoma. Coverage of the dura was required in 12 patients. Muscles used were the rectus abdominis and latissimus dorsi. Complications included flap necrosis (n = 2) and ventral hernia (n = 2). Control of pain was achieved in 66 percent of cases. Patients with regional metastasis died within 2 years, and those with distant metastasis died within 18 months. Patients with primary tumors had an increased survival rate. The authors confirm the technical feasibility and success of free flaps to reconstruct extensive defects in the skull base. In patients with potentially complete resection of primary/recurrent lesions, overall survival justifies the procedure. Patients with regional/distant metastasis warrant an individualized approach.