The anterolateral thigh free flap for skull base reconstruction

Objective: To assess outcomes of patients undergoing reconstruction after resection of skull base tumors with the anterolateral thigh (ALT) free flap. Study Design: Case series with chart review. Subjects and Methods: Thirty-four consecutive patients with cancers involving the skull base that underwent reconstruction with the ALT free flap between 2005 and 2008 were reviewed. Results: The ALT free flap was successfully used to reconstruct two, five, and 17 anterior, lateral, and posterior skull base defects, respectively. In addition, six and four combined anterior-lateral and lateral-posterior defects, respectively, were reconstructed. The overall complication rate was 29 percent. There were no flap losses. Nerve grafts (n = 6) and fascial slings (n = 14) for facial reanimation were performed using the lateral femoral cutaneous nerve and fascia lata from the same donor site as the ALT free flap. By harvesting the flap and graft(s) simultaneously with the resection, an average of 3.0 hours per case was saved. Conclusions: The ALT free flap is a versatile, reliable flap that should be considered a first-line option for skull base reconstruction. Operative time is minimized by performing a simultaneous two-team approach to resection and reconstruction, and by harvesting nerve, vein, and fascial grafts from the same donor site as the flap.