Microvascular Free Tissue Transfer for Reconstruction of Anterior Skull Base Defects

Background We present our experience with free flap reconstruction of the anterior skull base (SB), focusing on complex composite defects in patients undergoing multimodality therapy for SB tumors. Methods Outcomes of patients undergoing anterior SB free flap reconstruction were retrospectively analyzed. Results Sixty‐three free flap reconstructions of the anterior SB were performed. Open maxillectomy (56%) and craniofacial resection (46%) were the most common ablative approaches. The anterolateral thigh (ALT) flap was the most common reconstructive method (84%), including chimeric ALT flaps used in 70% of the patients to reconstruct defects that encompassed more than one subsite. Twenty‐one (33%) patients experienced a complication within 30 days after reconstruction. There were no cases of surgical mortality. Conclusions Microvascular free tissue transfer is an effective reconstructive option for the anterior SB. Chimeric free flaps are often best suited for the reconstruction of the anterior SB due to the flexibility of inset, allowing adjacent areas to be reconstructed without adding undesirable bulk.