Description: This 30-minute instructional lecture offers a focused overview of endonasal mucosal and regional flaps, which are integral to reconstruction in endoscopic sinus and skull base surgery. With the expansion of endoscopic approaches to address a wide spectrum of skull base and sinonasal pathologies, the need for reliable closure techniques has become paramount. Vascularized flaps have proven essential in minimizing complications such as cerebrospinal fluid (CSF) leaks, infections, and delayed healing.

The lecture begins with a concise review of relevant nasal and skull base anatomy, followed by an in-depth discussion of the most commonly used flaps. Emphasis will be placed on the Hadad-Bassagasteguy nasoseptal flap due to its versatility and widespread application. Additional mucosal flaps—including the inferior turbinate, middle turbinate, and lateral nasal wall flaps—will be introduced as alternatives for smaller or anatomically constrained defects. The role of regional flaps, such as the pericranial and temporoparietal fascia flaps, will be briefly covered for use in extended defects or revision surgery.

Participants will learn techniques for flap design, elevation, and inset, supported by high-definition surgical video and illustrative case examples. Key considerations such as flap selection based on defect location, vascular pedicle preservation, and handling of intraoperative complications will be addressed.

Outcomes: By the end of the session, participants will:

·       Understand the anatomical foundations and surgical principles underlying the use of endonasal mucosal and regional flaps.

·       Be able to identify appropriate flaps for various skull base defect locations and sizes.

·       Gain familiarity with technical steps for safe and effective flap harvesting and inset.

·       Recognize common challenges and complications in flap-based reconstruction and strategies for management.

·       Be prepared to integrate reconstructive planning into routine endoscopic sinus and skull base procedures.

Objectives: At the conclusion of this lecture, attendees will be able to:

1.     Describe the key anatomical landmarks and vascular supply relevant to mucosal and regional flap design in endoscopic surgery.

2.     Differentiate between the primary types of endonasal mucosal flaps and regional flaps, including their indications and limitations.

3.     Demonstrate the basic principles of harvesting, positioning, and securing mucosal and regional flaps using endoscopic techniques.

4.     Select the most appropriate flap type based on surgical defect characteristics and reconstructive requirements.

5.     Manage common intraoperative and postoperative complications associated with flap-based reconstruction.