Arch Craniofac Surg.  2021 Oct;22(5):232-238. 10.7181/acfs.2021.00290.

Anterior skull base reconstruction using an anterolateral thigh free flap

  • 1Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
  • 2Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
  • 3Departments of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
  • 4Departments of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea


Galeal or temporalis muscle flaps have been traditionally used to reconstruct skull base defects after tumor removal. Unfortunately, these flaps do not provide sufficient vascularized tissue for a dural seal in extensive defects. This study describes the successful coverage of large skull base defects using anterolateral thigh (ALT) free flaps.
This retrospective study included five patients who underwent skull base surgery between June 2018 and June 2021. Reconstruction was performed using an ALT free flap to cover defects that included the intracranial space and extended to the frontal sinus and cribriform plate.
There were no major complications, such as ascending infections or cerebrospinal leakage. Postoperative magnetic resonance imaging showed that the flaps were well-maintained in all patients.
Successful reconstruction was performed using ALT free flaps for large anterior skull base defects. In conclusion, the ALT free flap is an effective option for preventing communication between the nasal cavity and the intracranial space.


Free tissue flaps / Reconstructive surgery / Temporal artery
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