====== Nasoseptal flap ====== {{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1LU7YBGfC-yLn-_7XeZ0ontvbiFg7vOeeHikcfVheXVDB3hojx/?limit=15&utm_campaign=pubmed-2&fc=20240123134446}} The nasoseptal flap, also known as the Hadad-Bassagasteguy flap (HB flap), was developed at the University of Rosario, [[Argentina]], and the University of Pittsburgh and was first described in [[2006]] ((Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, Mintz A. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope. 2006 Oct;116(10):1882-6. doi: 10.1097/01.mlg.0000234933.37779.e4. PMID: 17003708.)) ---- The development and widespread utilization of the nasoseptal [[flap]] has revolutionized [[anterior skull base]] [[reconstruction]]. Before the [[description]] of the nasoseptal flap in [[2006]], other local vascularized flaps such as the pericranial or temporoparietal [[fascia]] flaps were utilized and conveyed potentially unnecessary morbidity to patients. Reconstruction of the [[anterior skull base]] does not always require a vascularized tissue flap and can often be achieved with non-vascularized [[autologous]] or synthetic [[graft]]s. However, large [[skull base defect]]s involving high-flow [[cerebrospinal fluid leak]]s require vascularized tissue [[reconstruction]] to avoid post-operative CSF leak and resultant [[complication]]s. The nasoseptal flap utilizes [[mucosa]] based on a vascular pedicle within the [[nasal cavity]] that minimizes [[morbidity]] and maximizes success for anterior skull base surgical procedures ((Hoerter JE, Kshirsagar RS. Nasoseptal Flap. 2022 Dec 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 35015408.)). ---- The reliable vascular supply promotes rapid healing and the flap is an effective barrier for the prevention of CSF leaks. For large skull base defects, it has dramatically decreased the risk of a postoperative CSF leak to less than 5%. The nasoseptal flap is a versatile flap with a wide arc of rotation that allows the flap to reach defects from the frontal sinus to the lower clivus ((Pinheiro-Neto CD, Snyderman CH. Nasoseptal flap. Adv Otorhinolaryngol. 2013;74:42-55. doi: 10.1159/000342271. Epub 2012 Dec 18. PMID: 23257551.)). ===== Nasoseptal flap for anterior skull base reconstruction ===== [[Nasoseptal flap for anterior skull base reconstruction]] ---- ===== Flap Harvesting ===== The nasoseptal flap is harvested from the [[nasal septum]], which is the wall of tissue that separates the left and right [[nostril]]s. It is a vascularized flap, meaning it contains blood vessels that contribute to its viability. ===== Versatility ===== The nasoseptal flap is versatile and can be used to reconstruct various areas of the anterior skull base, including the [[sella turcica]], [[planum sphenoidale]], and [[tuberculum sellae]]. ===== Vascular Supply ===== The flap's vascular supply is derived from the [[anterior ethmoidal artery]], a branch of the [[ophthalmic artery]]. The vascularization of the flap enhances its survival and promotes effective healing in the reconstructed area. ===== Coverage and Support ===== The nasoseptal flap is designed to provide coverage and support to the [[skull base]] defect created during surgery. It helps prevent complications such as [[cerebrospinal fluid leak]]s, which can occur when there are breaches in the dura mater. ===== Technique ===== The flap is typically elevated and rotated into position to cover the defect. Care is taken to ensure a [[watertight]] seal and proper positioning to optimize healing. ===== Prevention of Complications ===== The use of the nasoseptal flap is particularly effective in preventing CSF leaks, a common concern in anterior skull base surgery. It reduces the risk of [[postoperative infection]]s and other complications related to skull base defects. ===== Advantages ===== The flap is an [[autograft]], meaning it comes from the patient's tissue, reducing the risk of rejection. Its proximity to the surgical site simplifies the harvesting process. ===== Postoperative Care ===== Close postoperative monitoring is essential to detect any signs of complications, and imaging studies may be performed to assess the success of the reconstruction. In summary, the [[nasoseptal flap]] is a valuable tool in anterior skull base reconstruction. Its vascularized nature, ease of harvest, and versatility make it a preferred choice for surgeons performing endoscopic endonasal skull base surgery, especially when dealing with lesions or tumors in the sella turcica and adjacent areas. ---- ---- The Hadad-Bassagasteguy vascularized [[nasoseptal pedicled flap]] (HBF) is an effective technique for the reconstruction of skull base defects with a low incidence of postoperative [[cerebrospinal fluid leak]]. Advanced planning is required as posterior septectomy during transsphenoidal surgery can preclude its use due to the destruction of the vascular pedicle. [[Endonasal Approach]]es (EEAs) have been widely used for various skull base lesions. The reconstruction of the skull base defects is of vital importance to prevent postoperative complications. The vascular pedicled-nasoseptal flap (Hadad-Bassagasteguy flap) is used as a workhorse in reconstruction of majority of the defects. MRI is a very useful tool in assessing the viability of the flap postoperatively and to evaluate for variations that may suggest potential flap failure ((Jyotirmay H, Saxena SK, Ramesh AS, Nagarajan K, Bhat S. Assessing the Viability of Hadad Flap by Postoperative Contrast-Enhanced Magnetic Resonance Imaging. J Clin Diagn Res. 2017 Jun;11(6):MC01-MC03. doi: 10.7860/JCDR/2017/26737.10118. Epub 2017 Jun 1. PubMed PMID: 28764208; PubMed Central PMCID: PMC5535400. )).