Scalp necrosis following decompressive craniectomy in pediatric patient populations: illustrative case.

Background: Full-thickness scalp necrosis is a rare complication following decompressive craniectomy (DC), leaving the underlying dura mater and brain vulnerable to infection and further injury. The authors describe a case of scalp necrosis extending down to the dura in a 2-year-old male following emergency frontotemporoparietal DC, in addition to the method used for reconstruction of both the large scalp defect and the underlying skull defect. The results of a systematic review of reconstruction of combined scalp and calvarial defects are also presented.

Observations: Following debridement of the necrotic scalp, serial flap advancements were performed for temporary dural coverage, with a dermal matrix placed over the dura. Definitive reconstruction was performed using tissue expansion, a polyetheretherketone implant, and rotation of the expanded flap. In a review of the literature, 14 cases met the inclusion criteria. The mean patient age was 9 months, and the mean size of the scalp defect was 61 cm2. An algorithm for acute and long-term management and reconstruction of composite scalp and calvarial defects is proposed.

Lessons: Long-term reconstruction of pediatric scalp defects following DC requires a multidisciplinary approach based on patient factors including etiology of injury, patient age, size of the defect, and potential for hair regrowth. https://thejns.org/doi/10.3171/CASE24614.