Occipital galeopericranial pedicled flap, transparapharyngeal and transpterygoid transposition: a new flap for skull base reconstruction.

Reconstruction of small dural defects is independent of which technique is used, and vascularized tissue does not appear to be critical. In contrast, large dural defects have been traditionally repaired using regional vascularized flaps, as they promote healing and diminish complications. Recently, novel regional vascularized flaps that do not require cutaneous incisions have been designed: nasoseptal (NS) flap, posterior pedicled inferior turbinate (IT) flap, and pedicled palatal flap. The development of the NS flap has partially overcome the challenge of obtaining vascularized tissue to cover large defects after EEA. However, these flaps cannot be used in patients who have undergone previous posterior septectomies, wide sphenoidotomies, or have tumor involvement of the septum. In an attempt to use new sources of vascular supply and to keep pace with rapidly expanding reconstructive requirements, we investigated the anatomical foundations for novel modifications of the occipital galeopericranial (OGP) flap for reconstruction of skull base defects. Occipital Galeopericranial Pedicled Flap, Transparapharyngeal and Transpterygoid Transposition: a New Flap for Skull Base Reconstruction