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.
Copyright © 2021 by Mutaz B. Habal, MD.