Coverage of necrosis after secondary cranioplasty using a latissimus dorsi muscle flap.

Secondary cranioplasty aims to restore skull integrity after decompressive surgery but can be complicated by rare issues such as skin necrosis. We report a case of a 70-year-old female with multiple comorbidities who developed extensive scalp necrosis following cranioplasty. Surgical revision revealed significant dural exposure, requiring reconstruction with a free latissimus dorsi flap and a split-thickness skin grafting. Microvascular anastomosis was performed using the superficial temporal vessels. At 8-week follow-up, the site was fully healed without infection or recurrent necrosis. This case underscores the effectiveness of the latissimus dorsi free flap in managing large cranial defects, especially in patients with complex vascular conditions.