The Use of the Composite Muco-perichondrial-cartilaginous Vascularised Septal Flap in the Reconstructive Surgery of the Skull..

The original vascularised nasoseptal mucoperichondrial flap was described and used, in the endoscopic reconstructive surgery of the skull base tumors, for the first time in 2006, by two surgeons, Hadad and Bassagasteguy [1]. This kind of vascularised flap provides the surgeons the ability to close large skull base deffects after removing sinonasal tumors. The vascularisation is provided by the posterior septal branch of the spheno-palatine artery [1]. The flap is well vascularised and the surgeon is able to harvest a large surface flap using almost all septal mucosa from one nostril. Sometimes, if the defect that had to be reconstructed was very large, some authors reported that they harvested the nasal mucosa from the nasal floor too. Some modifications were reported on patients where the flap was created by using bilateral nasal mucosa, but no advantage was gained by sub-maximal, bilateral septal flap harvesting as compared to a single, large, long, unilateral flap, taken to the vestibular skin anteriorly and to the inferior meatus laterally including the palatal floor [2,3]. Bilateral mucosal elevation leaves denuded septal cartilage and bone on both sides of the septum which prolongs the return of nasal mucosal function unless a formal posterior septectomy is also performed. The large surface area of the nasoseptal flap allows great versatility of movement [4]. It is capable of reaching any single segment of the ventral skull base, including the sella turcica, planum sphenoidale, clivus or the cribriform plate [4,5]. At its largest dimension, the nasoseptal flap is able to cover an entire anterior craniofacial defect from the frontal sinus to the planum sphenoidale and from orbit to orbit. The good vascularisation of the flap and the origin of the vascular source provide the surgeon with the ability to rotate the flap almost all directions [5].