Microvascular Reconstruction of Serious Frontal Sinusitis and Osteomyelitis after Frontal Craniotomy

Frontal craniotomy complicated with sinusitis and cutaneous fistula may lead to a great challenge of plastic surgeons due to large defect of composite tissue loss with erosion of frontal bone. Frontal osteomyelitis induced by sinusitis is the most frequent clinical presentation. To treat the complication, adequate antibiotics and surgical intervention should be performed at the same time. The purposes of reconstructive surgery are removal of all infection sources, separation of cranial content from nasal cavity and composite tissue repair. To reach these goals, free flap is the best choice because of the following advantages: one stage procedure including debridement and reconstruction, more resistant to recurrent infection due to rich of blood supply, available composite tissue for transposition, bulky effect of replacement for volume loss, easy way to design the size and shape of the flap for matching the defect.