Challenges of sinocutaneous fistula reconstruction: Current and emerging surgical management

Summary Sinocutaneous fistulas are persistent defects that create an abnormal connection between the facial skin and the paranasal sinuses, most commonly following severe trauma or unsuccessful surgical intervention. Effective management depends on establishing an airtight, well‐vascularised barrier through multilayer reconstruction techniques. Traditional methods primarily rely on periosteal and muscle flaps, which provide tissue coverage, vascular supply and mechanical support while protecting the wound from airflow contamination. Recently, the use of a titanium mesh has been introduced as an adjunctive option to provide additional structural support and act as a scaffold for tissue healing. Although this approach may offer advantages in complex defects, concerns remain regarding implant exposure and infection risk, necessitating implant removal. Consequently, mesh‐assisted reconstruction may be best reserved for cases with extensive tissue loss or inadequate structural support, ideally in combination with established multilayer closure techniques. Emerging strategies such as resorbable fixation systems, scaffold meshes, and patient‐specific 3D‐printed implants may further improve future reconstructive outcomes.