Stepwise Reconstruction of a Large, Self-Inflicted Calvarial Defect.

BACKGROUND AND

IMPORTANCE

Scalp expansion ensures that tissue similar in color, texture, thickness, and most importantly, hairbearing quality, is available to resurface the scalp. It is a critical option for reconstruction of large calvarial defects.

CLINICAL PRESENTATION: Over 6months, a 55-year-old male patient excoriated his scalp into a full-thickness scalp and calvarial wound resulting in dural violation and meningitis. The patient presented with altered mental status and methicillin-susceptible staphylococcus aureus (MSSA) bacteremia, cranial osteomyelitis, and an intracranial abscess secondary to the large scalp defect. The patient underwent immediate debridement and dural coverage with a scalp rotational flap. Several months later he began delayed stepwise cranioplasty with multiple scalp tissue expanders given the deficiency of soft tissue.

CONCLUSIONS

This case is presented to highlight the unusual mechanism of injury and the complex reconstructive approach in surgical management.