Nasoseptal flap

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 grafts. However, large skull base defects involving high-flow cerebrospinal fluid leaks require vascularized tissue reconstruction to avoid post-operative CSF leak and resultant complications. 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.

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. Since then, there have been many theorized augmentations, proposed expansions, and enhanced indications for its use ¹⁾.