Reconstruction of the pedicled nasoseptal flap donor site with a contralateral reverse rotation flap: Technical modifications and outcomes

Objectives/Hypothesis A pedicled nasoseptal flap is our preferred reconstructive technique after endoscopic endonasal skull base surgery. Its harvesting implies that the donor site (septal cartilage) is left bare. Secondary healing leads to crusting at the donor site that negatively affects the patient's quality of life and requires multiple outpatient debridements. A nasoseptal reverse rotation flap was designed to eliminate this problem; however, its outcomes have not been reported. Study Design Retrospective review. Methods We retrospectively reviewed the clinical charts of patients who underwent endoscopic endonasal skull base surgery at the Wexner Medical Center at The Ohio State University from November 2010 to September 2012, and in whom a reverse flap was used. We analyzed patients' demographics, pathology, and outcomes regarding the reverse flap. Results Forty-nine patients with various pathologies were included (11 meningiomas, seven craniopharyngiomas, five pituitary macroadenomas, five chondrosarcomas, five meningoencephaloceles, three chordomas, 11 malignant tumors, two other lesions). There were two patients lost to follow-up. Mean follow-up time was 11 weeks (range = 1-39 weeks). A follow-up examination 1 to 2 weeks after surgery revealed a complete re-epithelialization in 46 of 47 patients (97.87%). Adverse events included granuloma (n = 1), anterior dehiscence (n = 1), and excoriated mucosa (n = 1). Factors such as underlying disease, prior chemoradiotherapy, and postoperative chemoradiotherapy did not seem to affect the healing of the reverse flap. Conclusions The reverse flap provides complete remucosalization of the denuded donor septum, decreasing septal crusting within the first 1 to 2 postoperative weeks, and adds minimal morbidity.