Use of Free Flaps in the Reconstruction of the Ventral Skull Base: A Systematic Literature Review

Background: Reconstruction of the ventral skull base represents a challenge in head and neck surgery. When local or regional flaps are insufficient, microvascular free flaps offer a reliable reconstructive option. Methods: A systematic literature review was conducted following PRISMA guidelines to identify studies on ventral skull base reconstruction using microvascular free flaps. Eligible studies included cases with an explicit description of the flap type, recipient vessels, and transposition corridor. The authors propose a categorization of the surgical corridors used for pedicle transposition to optimize result interpretation. Results: Thirty-seven studies encompassing 147 patients met inclusion criteria. A possible preferential association between site, corridor, and flap can be suggested. Conclusions: This study supports the role of a tailored selection of surgical corridors and recipient vessels in optimizing ventral skull base reconstruction. Moreover, it emphasizes the importance of matching anatomical feasibility with flap and patient's characteristics.