Radial forearm free flap with titanium mesh sandwich reconstruction in complex anterior skull base defects

Background: Skull base reconstruction presents a number of challenges from anatomical and functional perspectives. This is especially the case with large anterior skull base defects with compromised recipient beds from repeated infection, multiple surgeries, or previous radiation. The purpose of the study was to demonstrate the use of the titanium mesh/radial forearm free flap (RFFF) mesh sandwich for reconstruction of large anterior skull base defects with a poor recipient bed or excessive bony defect. Methods: Retrospective case series of 3 patients with complex anterior skull base defects reconstructed with a titanium mesh/RFFF mesh sandwich technique. Results: Reconstruction of 3 cases using the titanium mesh/RFFF sandwich technique resulted in definitive treatment with no recurrent cerebral spinal fluid leaks, meningitis, or complications. Conclusions: The titanium mesh/RFFF sandwich is an excellent reconstructive option for large anterior skull base defects with a poor recipient bed. This approach is facilitated using a combined open and endonasal endoscopic approach in a multidisciplinary team composed of head and neck surgery, rhinology, and neurosurgery.