Vascularized reconstruction of endoscopic skull base defects

Vascularized flap reconstruction is an effective reconstructive procedure for the management of complex skull base defects. The workhorse of endonasal reconstruction is the nasoseptal flap, which is a versatile pedicled flap with reliable vascularity that may be harvested using a purely endoscopic technique. Bilateral nasoseptal flaps may also be harvested for the coverage of very large defects. Several technical considerations may improve the ease of harvest and prevent postoperative complications.