Stepwise Reconstruction of a Large, Self-Inflicted Calvarial Defect

J Craniofac Surg. 2022 Jun 1;33(4):1116-1117. doi: 10.1097/SCS.0000000000008192. Epub 2021 Sep 22.


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.

Publication types

  • Case Reports

MeSH terms

  • Humans
  • Male
  • Middle Aged
  • Plastic Surgery Procedures* / methods
  • Scalp* / injuries
  • Scalp* / surgery
  • Self-Injurious Behavior*
  • Surgical Flaps
  • Tissue Expansion Devices