Purpose
The evolution of reconstructive methods has extended the boundaries of resectability of complex anterior skull base tumours. We highlight a specific case example within our series of free chimeric scapula tip reconstructions using free rib, scapula tip, thoracodorsal artery perforator, parascapula perforator and latissimus dorsi to reconstruct extended anterior skull base defect including sub-total nose, maxillectomy, ethmoidectomy, frontal sinus and orbital exenteration. We aim to illustrate the versatility of this evolving technique and the positive functional and cosmetic outcomes that are possible.
Methodology
A retrospective case review of five patients results. Medical notes were analysed looking at outcomes with an emphasis on function, quality of life and cosmetic scoring.
Results
Excellent functional results were achieved in all our cases, with MD-Anderson-Dysphagia-Inventory (MDAI): 92, Washington Quality of life score 79, with all patients returning to work or normal activity, and little donor-site morbidity, DASH: 18.75 (2.5 to 41.67). In our fifth case instead of using a separate free fibula as in two previous cases, we used a further vascularised rib component within the chimeric flap to reconstruct frontal bar and nasal support. This had the advantage of only one anastamosis and a particularly long pedicle with reduced donor site morbidity.
Conclusion
A chimeric scapular tip flap is ideal for complex anterior skull base reconstruction. It has the advantage of being versatile, with a long pedicle and has multiple constituents that can fit a variety of defects. Having independent paddles allows for extensive composite reconstruction with the possibility of dental rehabilitation. Using vascularised rib as another component of the chimeric flap reduces donor site morbidity and provides an excellent boney framework for difficult reconstruction.