Guidelines for Complications of Cancer Treatment Vol VIII Part B

to the muscle to recreate the orbital roof. It islimited by its narrow arc of rotation.ii) Pedicled myocutaneous flaps: These may bederived from pectoralis major, trapezius, latissimusdorsi, or sternocleidomastoid muscle. They offermore bulk and coverage then the local flaps;however some authors have reported highercomplication rates, when compared to the freeflaps.iii) Free tissue transfer (free flaps): These flaps haverevolutionized the skull base reconstruction. Theyprovide large volume of flexible vascularised tissueand are ideal in case of extensive resectioninvolving removal of dura, bone, muscle and skin.They are optimal for patients who have undergoneprevious surgery or radiotherapy. These flaps canbe harvested from latissimus dorsi, rectusabdominus, radial forearm, scapula, paascapula,and anterolateral thigh.c) Repair of the large bony defect by vascularised bonegraft or titanium mesh, if required.d) Lastly, the judicious use of lumbar drainage to decreaseCSF pressure and to provide alternate drainage till thewound heals. Prophylactic lumbar drainage is acontentious issue with divided opinion on its use. Withimproving methods of reconstruction, it is best to reserveit for early postoperative leaks or to prophylacticallyuse it to support a suboptimal repair.Diagnosis of Leak The diagnosis is usually evident in most cases. Veryoccasionally the leak is intermittent and clinically247