The Chinese carpet flap for anterior cranial fossa reconstruction in cases of depressed frontal fractures: 10 years' experience at a tertiary referral center.

Frontal sinus fractures account for 5–15% of facial injuries and endanger adjacent vital structures. We retrospectively analyzed 89 depressed frontal sinus fractures reconstructed with a pericranial flap (PCF) harvested in 29 of them at a tertiary center between 2014 and 2024 (MFM.IRB.ID code: R.25.08.3314). Most patients were young men (mean 18.3 ± 4.1 years); mechanisms included falls (42.7%) and motor-vehicle collisions (39.3%). Fracture types were isolated anterior table (n = 54), combined anterior/posterior tables (n = 35), and nasofrontal outflow tract (NFOT) involvement (n = 8). Using a bicoronal approach, we cranialized NFOT-disrupted sinuses, repaired dura in 33 cases, and rebuilt orbits as required. The vascularized “Chinese-carpet” PCF was split or folded to achieve multilayer anterior skull-base coverage without donor-site morbidity. Forehead projection improved by 3.4 ± 1.7 mm (range 2.9–16.8 mm). Over a 39.2-month mean follow-up, no cerebrospinal fluid leaks occurred. Minor complications included transient alopecia (n = 33), scalp paresthesia (n = 57), and five mucoceles managed conservatively. Our decade-long experience supports the PCF as a versatile, dependable option for complex frontal sinus reconstruction; larger multicenter studies should confirm its long-term efficacy.