A pedicled posterior septal-nasal floor (PS-NF) flap and a novel rescue flap for skull base reconstruction: technical note.

Abstract Objective We have devised a new surgical alternative to the conventional nasoseptal flap, a pedicled posterior septal–nasal floor flap that we named the Kegon flap. We evaluated the effectiveness of this flap for skull base reconstruction in patients with high-flow cerebrospinal fluid (CSF) leakage after sellar/parasellar tumor resection. Methods The Kegon flap with a novel rescue flap is designed to preserve blood flow and mucosa anterior to the nasal septum and to avoid flap damage during surgery. We retrospectively evaluated postoperative flap perfusion with T1-weighted contrast-enhanced magnetic resonance imaging (MRI) and characterized complications and wound healing in five patients who experienced high-flow CSF leakage after sellar/parasellar tumor resection requiring reconstruction. Results Postoperative T1-weighted contrast-enhanced MRI demonstrated good flap perfusion in all patients. The area reconstructed with the Kegon flap healed within the first month following surgery. No postoperative CSF leakage or nasal hemorrhage were observed. There was no perforation of the anterior nasal septum after surgery. The mucosal defect had completely epithelialized in all patients by 3 months after surgery. There were no instances of prolonged nasal crusting or any subjective decrease in olfactory function 3 months after surgery. Conclusion The use of a Kegon flap with a novel rescue flap was effective and helped preserve nasal structure and function in patients undergoing skull base reconstruction after sellar/parasellar tumor resection associated with high-flow CSF leakage.