Immediate reconstruction of contaminated central craniofacial injuries with free autogenous grafts

Abstract

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.

Rhinocerebral Mucormycosis: A Retrospective Study

“…Infection most often develops in individuals with immunologically compromising conditions which are frequently the result of diabetes mellitus, cancer, chemotherapy or administration of immunosuppressive medications following organ transplantation [4][5][6][7]. Other predisposing factors include renal failure, severe burns, malnutrition, neutropenia and treatment with desferoxamine.…”

“…Other predisposing factors include renal failure, severe burns, malnutrition, neutropenia and treatment with desferoxamine. Patients without an underlying abnormality or apparent predisposition have also been affected [4,8]. The incidence of disease has not been demonstrated to vary based on age or gender.…”

Zygomycetes in Human Disease

“…The mechanism by which the corticosteroids enhance susceptibility to developing zygomycosis is probably twofold. First, steroids suppress the normal inflammatory cell response that would otherwise occur, and second, they may induce a diabetic state (291). Other immunocompromised states such as organ or bone marrow transplantation also contribute to the underlying risk factors for developing disease with these opportunistic infections (54,160,190,196,308).…”

“…The use of broad-spectrum antibiotics has also been associated with an increased risk of developing zygomycosis. Presumably, elimination of the normal flora by antibiotic use allows the fungi to establish an infection in the absence of bacterial competition (166,291,463). For patients in whom myelosuppressive therapies have been administered and neutropenia and fever have persisted for longer than 7 to 10 days despite antibiotic therapy, a diagnosis of a fungal infection, including zygomycosis, should be suspected (60).…”

Rhino Cerebral Mucormycosis with Post Surgical Complications in Diabetes: A Case Report

“…kidney and liver. 11,12,15 The term rhinocerebral mucormycosis (RCM) should be used when the paranasal sinuses, orbit and brain are Photomicrograph from retro-molar region showing elongated, broad, non-septate branching hyphae within the tissue and the bone marrow space (Gomori methenamine silver nitrate stain, original magnification _400) infections. A few studies have shown that HBO has direct in vitro fungistatic activity and reduce tissue hypoxia, which may reverse the hypoxic acidosis that helps the fungi to proliferate 25 .…”