Post-traumatic fronto-ethmoid osteomyelitis treated with free muscle transfer

Abstract

Intractable frontal sinus infection after obliteration of the injured sinus and nasofrontal duct has become a less common injury nowadays. Adequate debridement complemented with a viable peri-cranial flap would usually prevent the troublesome frontal sinusitis. Nonetheless if recurrent infection involves both the frontal and ethmoid sinuses, local tissues may not suffice for obliteration of the dead space. We developed the use of a free vascularised muscle flap that may be the best option in treating osteomyelitic sinusitis. Three cases of intractable fronto-ethmoid osteomyeltic sinusitis treated by free vascularised tissue transfer are reported in this article. The use of free muscle flaps not only sealed the dead spaces with sufficient volume of viable tissue but also introduced vascularity into a relatively avascular zone. Furthermore, the advantages of microsurgical transfer allowed, without limiting the size of the free flap, a more extensive debridement which was the prerequisite for successful control of an infection.