Local Pedicled Flaps

Small cerebrospinal fluid leaks (CSF-L) of the anterior cranial fossa can be reconstructed with a wide variety of free grafting techniques, with a success rate of about 95%. However, when applied to the larger and more complex skull base defects, these techniques might be inadequate. In these cases, the use of pedicled vascularised flaps provides very strong support and rapid healing, showing a decrease in post-operative CSF-L rates to <5%. Among flaps, Hadad-Bassagasteguy flap (HBF) is the most used, due to its ease of harvesting and wide coverage area. However, the HBF may not be adequate for the repair of anterior defects and may be unavailable in some situations. Therefore, many other pedicle flaps have been developed. Harvesting technique and indications of the main pedicled nasal flaps are described in detail in this chapter. Finally, general surgical aspects of duraplasty and anatomical-mechanical factors that may affect skull base reconstruction are reported.