The posterior pedicled inferior turbinate-nasoseptal flap: a potential combined flap for skull base reconstruction

Objectives To develop a combined pedicled flap comprising the mucoperiosteum and mucoperichondrium of the inferior turbinate, lateral nasal wall, nasal floor, and nasal septum based on the posterior lateral nasal artery, a branch of the sphenopalatine artery, for the reconstruction of skull base defects resulting from endoscopic expanded endonasal approaches. Methods Eleven fresh adult cadaver heads were dissected. Arterial distribution patterns of the inferior turbinate, lateral nasal wall, nasal floor, and nasal septum were investigated. The posterior pedicled inferior turbinate-nasoseptal flap was designed, measured, and harvested, and its ability to cover ventral skull base defects was examined. Results The inferior turbinate artery and/or posterior lateral nasal artery had 3.19 +/- 1.47 (range 2-7) branches [mean outer diameter of largest branch, 0.40 +/- 0.10 (range 0.24-0.60) mm] that anastomosed with the nasoseptal artery. These anastomosing arteries allowed the posterior lateral nasal artery to supply arterial blood to the nasoseptal mucoperichondrium and mucoperiosteum. Mean flap length was 100.65 +/- 5.61 (range 91.43-109.44) mm, and minimum and maximum widths were 25.21 +/- 2.29 (range 22.36-30.23) and 44.53 +/- 5.02 (range 36.45-54.10) mm, respectively. Mean flap area was 3090.69 +/- 288.08 (range 2612.97-3880.09) mm(2). The flap covered defects extending from the frontal sinus to the foramen magnum in all specimens. Conclusions Harvesting of a posterior pedicled inferior turbinate-nasoseptal flap is feasible. It should be considered a useful option for the reconstruction of large defects involving the anterior skull base, planum sphenoidale, sella turcica, and/or clivus.