Severe cranial trauma caused by an industrial accident resulted in loss of scalp, skull, dura, and brain tissue in the left frontal region of a 55-year-old man. Successful one-stage total reconstruction of the defect was accomplished using a patch of fascia lata, autogenous split rib graft, and a free forearm flap on an emergency basis. A ten-month follow-up showed uneventful recovery and a good cosmetic result.