Microvascular free flaps in skull base reconstruction.

The anatomical challenges of skull base surgery are well known. Furthermore, ablative and traumatic defects in this region produce complex reconstructive problems with a high risk of significant postoperative morbidity and mortality. Over the past two decades, microvascular free tissue reconstruction following open resection has been shown to improve outcomes and reduce complication rates when compared to the traditional use of pedicled flaps. The increasing use of free tissue transfer has been further strengthened by improved technical expertise and high flap success rates. Since the size and type of free tissue to be utilized must be individualized to each defect, the accomplished reconstructive surgeon should be extremely versatile and, by extension, facile with a several types of free flaps. Thus, four of the most commonly used flaps--the rectus abdominis, radial forearm, latissimus dorsi and anterolateral thigh flaps--are discussed.