Immediate reconstruction of contaminated central craniofacial injuries with free autogenous grafts

Free autogenous osseous and soft tissue grafts were used for the immediate, one-stage reconstruction of central craniofacial injuries involving the frontal sinus in 95 patients with wounds contaminated by either skin or nasal bacteria. Graft removal and delayed reconstruction were necessary in only one patient who suffered an infection in the first postoperative week. To date, no delayed complications are known to have occurred in any patient. As anticipated, long-term follow-up has been erratic (6 weeks to 5 years) and only suggestions rather than definite guidelines for the management of the sinus component of the injury can be made. However, this group of patients clearly demonstrates that multiple free autogenous grafts can be safely used for the acute reconstruction of contaminated central craniofacial fractures that are intimately related to the intracranial structures.