The Role of Free Tissue Transfer in the Management of Chronic Frontal Sinus Osteomyelitis

Introduction: Chronic frontal sinus infection is managed with a combination of medical and surgical interventions. Frontal bone osteomyelitis as a sequela of recurrent infection following trauma or prior open surgery may require more significant debridement. Free tissue transfer may allow for extensive debridement with replacement of tissue, and definitive eradication of infection.

Methods: Retrospective chart review of 15 patients undergoing free flap obliteration of the frontal sinus for chronic infection and osteomyelitis at a single institution. Clinical, radiologic, and surgical data were collected. Surgical treatments before and after free flap obliteration were compared by Wilcoxon’s signed-rank test to assess resolution of infection.

Results: Mean number of surgeries for chronic frontal infection prior to free flap was 3.5 (range: 1–8). Free flap obliteration resolved chronic frontal osteomyelitis and sinusitis in all patients. Two patients experienced postoperative infection, and overall complication rate was 26.7%. Eight patients underwent cranioplasty (6 immediate, 2 delayed) without complication. All patients received planned courses of postoperative antibiotics. A statistically significant decrease in the number of surgeries after free flap obliteration was observed (p < 0.01).

Conclusion: Extensive debridement followed by free tissue transfer and antibiotics offers a definitive treatment for complicated, recurrent frontal osteomyelitis. Simultaneous cranioplasty provides immediate protective and aesthetic benefit without complication. Consideration should be given for free tissue transfer and cranioplasty earlier in the algorithm for treatment of refractory frontal sinus infection and osteomyelitis.