The Treatment Of Skull Repair Material Exposed To Frontal Sinus

Objective To investigate the clinical effect of fascial flap,fascial skin flap or free musculocutaneous flap on skull repair material exposed to frontal sinus,combining frontal sinusitis surgery and obliteration.Methods From 2014 to 2015,after completing preoperative preparation,especially the cranial computer tomography(CT) and the vascular color Doppler ultrasonography on donor site,eliminating the operation contraindication,and controlling wound infection,there were 7 cases with skull repair material exposed to frontal sinus received fascial flap,fascial skin flap or free musculocutaneous flap transplantion combining frontal sinus surgery(one of them received multi-sinus fenestration because of anterior nasosinusitis) and obliteration to repair the exposed material.Among the 7 cases,3 cases applied axial pattern superficial temporal fascia flap,2 cases applied reversed-flow superficial temporal fascia skin flap,1 case applied free latissimus dorsi myocutaneous flap,1 case applied the fascial flap nearby the wound.There were 4 cases added to Vacuum Sealing Drainage(VSD) due to much inflammatory secretion.After the operation,the sensitive antibiotics were used for the treatment of infection,some drugs were administered to improve the regional circulation,and investigating wether the flaps are survive or not and other complications' situation.Results All 7 cases of transplanted fascial flap,fascial skin flap or free musculocutaneous flap survived.Only on 1 case who was applied axial pattern superficial temporal fascia flap and VSD,partial flap necrosis,used for frontal sinus obliteration,was revealed when demolitioning VSD because of poor blood supply by titanium mesh compression.Without the compression and necrotic tissue,the fascial flap survived.All of cases,the lesion shape were plump and symmetric with the contralateral.Compared with the original skin,the skin flap had color difference.With the follow-up of 2-14 months,6 of them over 6 months,all the patients were satisfied with the appearance,the color difference had decreased,no dizziness,headache ect.Original lesions were without following conditions such as sunken or bulge,skin ulceration,skull repair material exposed again,frontal sinus inflammation recurrence,surgical scar hyperplasia and so on.Conclusions Fascia flap,fascia skin flap or free myocutaneous flap transplantation combined with frontal sinus surgery and obliteration,not only repair the defect of skull and forehead skin,but also treat frontal sinuitis,obliterate the frontal sinus,avoiding the intracranial infeion caused by frontal sinus inflammation and abscess recurrence.The operation solves the problem about skull repair material exposure and infection from the cause of disease,and effectively prevents the material exposure recurrence.Accordingly,the surgery method is a safe and effective treatment of skull repair material exposed to frontal sinus.With no disfunction or appearance defect on original lesions,the patient satisfaction is high.