{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T08:41:41Z","timestamp":1792312901923,"version":"4.4.0"},"reference-count":43,"publisher":"Georg Thieme Verlag KG","issue":"S 02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg B Skull Base"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Objective\u2003Though microvascular free tissue transfer is well established for open skull base reconstruction, normative data regarding flap design and inset after endoscopic endonasal skull base surgery (ESBS) is lacking. We aim to describe anatomical considerations of endoscopic endonasal inset of free tissue transfer of transclival (TC) and anterior cranial base resection (ACBR) defects.<\/jats:p><jats:p>\n          Design and Setting\u2003Radial forearm free tissue transfer (RFFTT) model.<\/jats:p><jats:p>\n          Participants\u2003Six cadaveric specimens.<\/jats:p><jats:p>\n          Main Outcome Measures\u2003Pedicle orientation, pedicle length, and recipient vessel intraluminal diameter.<\/jats:p><jats:p>\n          Results\u2003TC and ACBR defects averaged 17.2 and 11.7\u2009cm2, respectively. Anterior and lateral maxillotomies and endoscopic medial maxillectomies were prepared as corridors for flap and pedicle passage. Premasseteric space tunnels were created for pedicle tunneling to recipient facial vessels. For TC defects, the RFFTT pedicle was oriented cranially with the flap placed against the clival defect (mean pedicle length 13.1\u2009\u00b1\u20090.6\u2009cm). For ACBR defects, the RFFTT pedicle was examined in three orientations with respect to anterior\u2013posterior axis of the RFFTT: anteriorly, posteriorly, and laterally. Lateral orientation offered the shortest average pedicle length required for anastomosis in the neck (11.6\u2009\u00b1\u20091.29\u2009cm), followed by posterior (13.4\u2009\u00b1\u20090.7cm) and anterior orientations (14.4\u2009\u00b1\u20091.1cm) (p\u2009&lt;\u20090.00001, analysis of variance).<\/jats:p><jats:p>\n          Conclusions\u2003In ACBR reconstruction using RFFTT, our data suggests lateral pedicle orientation shortens the length required to safely anastomose facial vessels and protects the frontal sinus outflow anteriorly while limiting pedicle exposure through a maxillary corridor within the nasal cavity. With greater understanding of anatomical factors related to successful preoperative flap planning, free tissue transfer may be added to the ESBS reconstruction ladder.<\/jats:p>","DOI":"10.1055\/s-0041-1722935","type":"journal-article","created":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T00:15:38Z","timestamp":1614039338000},"page":"e143-e151","source":"Crossref","is-referenced-by-count":4,"special_numbering":"S","title":["Anatomic Considerations of Microvascular Free Tissue Transfer in Endoscopic Endonasal Skull Base Surgery"],"prefix":"10.1055","volume":"83","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2682-3297","authenticated-orcid":false,"given":"Leila J.","family":"Mady","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology \u2013 Head and Neck Surgery, University of Pennsylvania, Philadelphia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas M.","family":"Kaffenberger","sequence":"additional","affiliation":[{"name":"University of Pittsburgh, Pittsburgh, Pennsylvania, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalil","family":"Baddour","sequence":"additional","affiliation":[{"name":"University of Pittsburgh, Pittsburgh, Pennsylvania, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Melder","sequence":"additional","affiliation":[{"name":"University of Pittsburgh, Pittsburgh, Pennsylvania, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neal R.","family":"Godse","sequence":"additional","affiliation":[{"name":"University of Pittsburgh, Pittsburgh, Pennsylvania, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Gardner","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl H.","family":"Snyderman","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario G.","family":"Solari","sequence":"additional","affiliation":[{"name":"University of Pittsburgh, Pittsburgh, Pennsylvania, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark W.","family":"Kubik","sequence":"additional","affiliation":[{"name":"University of Pittsburgh, Pittsburgh, Pennsylvania, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric W.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaum","family":"Sridharan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,2,22]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1288\/00005537-199006000-00011","article-title":"Anterior cranial base reconstruction: role of galeal and pericranial flaps","volume":"100","author":"C H Snyderman","year":"1990","journal-title":"Laryngoscope"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1002\/hed.20166","article-title":"Complications of craniofacial resection for malignant tumors of the skull base: report of an International Collaborative Study","volume":"27","author":"I 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