Salvage of a large exposed cranial implant on irradiated necrosed scalp using free latissimus dorsi and forehead flaps - a case report.

Abstract

Scalp necrosis following a cranioplasty and subsequent exposure of the implant is a dreaded complication and needs to be treated promptly. Conventionally, implant removal is often advised to prevent delayed infection. We present a case of a scalp necrosis following cranioplasty using a titanium mesh for a patient who had undergone glioma excision and radiation therapy. Using a latissimus dorsi free muscle flap, we salvaged the implant. Patient had a persistent dural leak which was addressed by a pedicled extended forehead flap and suction drain under the latissimus dorsi flap. We successfully stopped the cerebrospinal fluid leak and covered the defect adequately concluding that muscle flaps are very useful to salvage exposed implants.