Comparing Flaps and Artificial Dermis for Skull Base Osteoradionecrosis Repair in Nasopharyngeal Carcinoma

ABSTRACT Objective This study compares the effectiveness of pedicled flaps, free flaps, and artificial dermis in reconstructing skull base osteoradionecrosis (sbORN) in nasopharyngeal carcinoma (NPC) patients and evaluates their impact on long‐term survival. Methods A retrospective analysis of 210 NPC patients with sbORN who underwent endoscopic debridement and reconstruction between April 2018 and October 2024 was conducted. Patients were categorized into pedicled flap (104 cases), free flap (43 cases), and artificial dermis (63 cases) groups. Surgical success rates, complications, and survival outcomes were analyzed using statistical methods, including Kaplan–Meier, Cox regression analyses, t ‐tests, chi‐square tests, and non‐parametric rank‐sum test. Results The pedicled flap group had the highest surgical success rate (75%) compared to free flaps (53.5%) and artificial dermis (30.2%) ( p < 0.001). No significant differences were found in overall complications or ICU admission rates ( p > 0.05), though no pedicled flap patients required ICU care. Survival analysis showed a significantly lower mortality risk in the pedicled flap group than in the artificial dermis group (HR = 0.400, p = 0.019), while the free flap group had no significant difference ( p > 0.05). Conclusion Pedicled flaps demonstrated superior surgical success and long‐term survival benefits, suggesting they should be the preferred option for sbORN reconstruction. Future research should refine surgical techniques and explore novel reconstructive materials to optimize outcomes. Level of Evidence 3.