Vascularised local and free flaps in anterior skull base reconstruction
Defects of the frontoorbital complex subsequent to extensive tumor surgery or severe trauma often result in aesthetic and functional disharmonies. The long-term results of rehabilitation related to different materials and techniques are the subject of this study. From 1974 to 1996 altogether 127 patients with bony defects of the orbit and/or the skull base underwent surgery. All patients' data were documented prospectively from 1984 onwards. The results following reconstruction with autologous calvarian transplants in 52 patients were compared to those of a control group which received iliac bone or PMMA implants. Eighty-one bony defects (64%) resulted from tumor resection; 37 patients (29%) suffered from the effects of trauma. In 67 cases (53%) reconstruction was performed primarily, in 51 cases (40%) secondarily. Free or pedicled soft-tissue transplants were necessary in order to separate the orbit and the neurocranium in 26% of the defects. On the other hand, small, isolated defects of the orbital roof (7%) were left without any reconstructive procedure. Contrary to the iliac bone grafts, the calvarian transplants resisted secondary resorption. Postoperative infections appeared in two cases; loss of transplants was avoided entirely in the group of calvarian reconstructions in contrast to the alloplasts. The selection of a suitable donor site area and rigid fixation with microplates led to excellent esthetic results even in cases with large defects.