Septal flip flap after endoscopic unilateral resection of sinonasal tumors: a multicenter experience of 133 patients

Purpose: Skull base reconstruction after endoscopic resection of sinonasal tumors remains challenging, particularly in preventing cerebrospinal fluid leaks. Autologous grafts are traditionally favored, whereas non-autologous materials may reduce donor-site morbidity with similar success. In this study, we explore surgical outcomes in patients undergoing unilateral resection of sinonasal tumors reconstructed with the septal flip flap (SFF), focusing on the impact of graft type on the efficacy and safety of the reconstructive strategy. Methods: This multicenter retrospective cohort study included adult patients with malignant sinonasal tumors treated via unilateral endoscopic resection and SFF reconstruction. Clinical and surgical variables were analyzed to identify predictors of early postoperative complications and factors influencing hospitalization using univariate and multivariate methods. Results: A total of 133 patients were included. Early postoperative complications occurred in 9.7%, with 4.5% related to skull base reconstruction. No variables, including graft type, significantly predicted SB-related complications in univariate logistic regression. Autologous grafts were associated with increased use of adjuvant radiotherapy (67.1% vs. 36.8%, p = 0.015). Conversely, the median hospitalization was 7 days. Dura mater resection, autologous graft use, early complications, and prior treatment were independent predictors of prolonged hospitalization at multivariate linear regression. Conclusion: This multicenter study confirms SFF as a reliable and safe option for anterior skull base reconstruction following unilateral sinonasal malignancy resection. The technique achieved robust closure, no flap necrosis, and low reconstruction-related complication rates. Graft type did not significantly influence outcomes, although autologous grafts provided better integration in patients receiving adjuvant radiotherapy, while non-autologous substitutes proved equally safe and effective in selected unimodal settings.