Wound healing of mucosal autografts for frontal cerebrospinal fluid leaks--clinical and experimental investigations.

Wigand introduced in 1981 the concept of applying autogenous free mucosal grafts for small to middle-sized cerebrospinal fluid (CSF) leaks of the frontal skull base. This operative technique has proved to be successful in clinical use. However, the details of wound healing of the free graft and the host area of the skull base are largely unknown. We conducted a series of animal experiments using 21 rabbits. Standardized CSF leaks of the frontal skull base were created and then closed using free autogenous grafts from the nasal septum. Twenty specimens could be evaluated after different postoperative time intervals by means of conventional microscopy of histological serial sections. In addition, we carried out a small series of special clinical postoperative observations following routine sinus surgery for polypoid mucositis on our patients, applying free mucosal autografts to the intact frontal skull base. The autogenous free mucosal transplants underwent a rapid process of histological remodelling. All grafts showed a reduction in size of about 1/5. The respiratory epithelia mostly disappeared postoperatively. The main histological feature consisted of a fibrous transformation of the graft, starting 8 days postoperatively. The presented experiments and observations lay the foundation for optimizing the operative technique and the postoperative care of our patients suffering from CSF leaks.