The use of pedicle periosteal flap in plastic surgery of anterior skull base

In 12 cases of large traumatic defects of the anterior skull base plastic surgery was performed using large periostial flap to separate the nasopharynx from the extradural area. After a large biauricular scalp flap was formed, precise preparation of periostial flap was done. The bifronto-transfrontal sinus or transfrontal sinus approach was performed. Next cranialization of the frontal sinus was done and then it was filled with muscle. Afterwards the floor of the frontal sinus and skull base with defect were covered with periostial flap pedicled along supraorbital ridge. Finally irradiated homograft of dura or fascia lata was glued intradurally onto the place of the dural defect. In all of the patients CSF-rhinorrhea stopped immediately after surgery. Among patients observed from 2 to 4 years after surgery neither recurrent rhinorrhea nor infection appeared.