Use of the Omental Free Flap for Treatment of Chronic Anterior Skull Base Infections
Summary:. Chronic complications following anterior cranial fossa tumor extirpation, such as cerebrospinal fluid leak, meningitis, mucocele, pneumocephalus, and abscess, negatively impact patient quality of life. Robust vascularized tissue is generally required to adequately reconstruct and obliterat...
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Wolters Kluwer
2020-08-01
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Series: | Plastic and Reconstructive Surgery, Global Open |
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doaj-666619ef684a47bbac12a10c884e56f62020-11-25T03:07:15ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742020-08-0188e298810.1097/GOX.0000000000002988202008000-00044Use of the Omental Free Flap for Treatment of Chronic Anterior Skull Base InfectionsGeorge Kokosis, MD0Joshua Vorstenbosch, MD, PhD1Arianna Lombardi, BA2Meghana G. Shamsunder, MPH3Babak Mehrara, MD4Geoffrey E. Hespe, MD5Laura Wang, MD6Cameron W. Brennan, MD7Ian Ganly, MD, PhD8Evan Matros, MD, MMSc, MPH9From the * Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering, New York, N.Y.From the * Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering, New York, N.Y.From the * Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering, New York, N.Y.From the * Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering, New York, N.Y.From the * Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering, New York, N.Y.† Division of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, Mich.From the * Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering, New York, N.Y.‡ Department of Neurosurgery, Memorial Sloan Kettering, New York, N.Y.§ Division of Head and Neck Surgery, Memorial Sloan Kettering, New York, N.Y.From the * Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering, New York, N.Y.Summary:. Chronic complications following anterior cranial fossa tumor extirpation, such as cerebrospinal fluid leak, meningitis, mucocele, pneumocephalus, and abscess, negatively impact patient quality of life. Robust vascularized tissue is generally required to adequately reconstruct and obliterate this complex geometric space. The aim of this study was to describe outcomes and advantages of the omental flap for these defects. Following institutional review board approval, a prospective, reconstructive database was reviewed from 2011 to 2020. Four patients with chronic anterior skull base complications treated with omental flap reconstruction were identified, with chart reviews performed. Median time from the index operation until the complication ultimately required a free omental transfer was 7.3 years. All patients underwent adjuvant radiation with the indications for surgery, including cerebral abscess, recurrent meningitis, osteomyelitis, and pneumocephalus. All free flaps survived without any need for revision. There were no donor site complications. One patient had delayed healing at an adjacent nasal wound that healed secondarily. At a median follow-up of 19.4 months, none of the patients had recurrent infections. The omental free flap has a number of properties, which make it ideally suitable for anterior skull base defects. Its malleable nature combined with the presence of multiple vascular arcades enable flexibility in flap design to contour to the crevices of 3-dimensional skull base defects. Although other free flaps are available to the plastic surgeon, the versatility and reliability of the omentum make it a first-line consideration for anterior skull base reconstruction.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000002988 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
George Kokosis, MD Joshua Vorstenbosch, MD, PhD Arianna Lombardi, BA Meghana G. Shamsunder, MPH Babak Mehrara, MD Geoffrey E. Hespe, MD Laura Wang, MD Cameron W. Brennan, MD Ian Ganly, MD, PhD Evan Matros, MD, MMSc, MPH |
spellingShingle |
George Kokosis, MD Joshua Vorstenbosch, MD, PhD Arianna Lombardi, BA Meghana G. Shamsunder, MPH Babak Mehrara, MD Geoffrey E. Hespe, MD Laura Wang, MD Cameron W. Brennan, MD Ian Ganly, MD, PhD Evan Matros, MD, MMSc, MPH Use of the Omental Free Flap for Treatment of Chronic Anterior Skull Base Infections Plastic and Reconstructive Surgery, Global Open |
author_facet |
George Kokosis, MD Joshua Vorstenbosch, MD, PhD Arianna Lombardi, BA Meghana G. Shamsunder, MPH Babak Mehrara, MD Geoffrey E. Hespe, MD Laura Wang, MD Cameron W. Brennan, MD Ian Ganly, MD, PhD Evan Matros, MD, MMSc, MPH |
author_sort |
George Kokosis, MD |
title |
Use of the Omental Free Flap for Treatment of Chronic Anterior Skull Base Infections |
title_short |
Use of the Omental Free Flap for Treatment of Chronic Anterior Skull Base Infections |
title_full |
Use of the Omental Free Flap for Treatment of Chronic Anterior Skull Base Infections |
title_fullStr |
Use of the Omental Free Flap for Treatment of Chronic Anterior Skull Base Infections |
title_full_unstemmed |
Use of the Omental Free Flap for Treatment of Chronic Anterior Skull Base Infections |
title_sort |
use of the omental free flap for treatment of chronic anterior skull base infections |
publisher |
Wolters Kluwer |
series |
Plastic and Reconstructive Surgery, Global Open |
issn |
2169-7574 |
publishDate |
2020-08-01 |
description |
Summary:. Chronic complications following anterior cranial fossa tumor extirpation, such as cerebrospinal fluid leak, meningitis, mucocele, pneumocephalus, and abscess, negatively impact patient quality of life. Robust vascularized tissue is generally required to adequately reconstruct and obliterate this complex geometric space. The aim of this study was to describe outcomes and advantages of the omental flap for these defects. Following institutional review board approval, a prospective, reconstructive database was reviewed from 2011 to 2020. Four patients with chronic anterior skull base complications treated with omental flap reconstruction were identified, with chart reviews performed. Median time from the index operation until the complication ultimately required a free omental transfer was 7.3 years. All patients underwent adjuvant radiation with the indications for surgery, including cerebral abscess, recurrent meningitis, osteomyelitis, and pneumocephalus. All free flaps survived without any need for revision. There were no donor site complications. One patient had delayed healing at an adjacent nasal wound that healed secondarily. At a median follow-up of 19.4 months, none of the patients had recurrent infections. The omental free flap has a number of properties, which make it ideally suitable for anterior skull base defects. Its malleable nature combined with the presence of multiple vascular arcades enable flexibility in flap design to contour to the crevices of 3-dimensional skull base defects. Although other free flaps are available to the plastic surgeon, the versatility and reliability of the omentum make it a first-line consideration for anterior skull base reconstruction. |
url |
http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000002988 |
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