Two-stage cranial reconstruction with a custom-made titanium plate using a preliminary bipedicled scalp flap : A case report.

A 75-year-old woman presented with scalp and cranial defects caused by implant exposure, infection,and cranial necrosis following multiple craniotomies. To reduce the risk of complications after cranioplasty, weplanned a two-stage cranial reconstruction. A wide bipedicled scalp flap with a long longitudinal axis above the cranium covered the scalp defect after debridement, and skin grafting was performed on the periosteum after flap harvesting during the first surgery. A custom-made titanium plate was implanted under the bipedicled flap during the second cranioplasty 4 months after the initial surgery. The patient had no complications during the two surgeries, and her clinical course was uneventful for 6 months after the last surgery. Although a two-stage approach, our technique is relatively safe for patients who have previously undergone multiple surgeries and decreases the risk of postoperative complications due to the shorter exposure time of the titanium plate during the second surgery. J. Med. Invest. 72 : 185-188, February, 2025.