Inside Out Cranioplasty: A Novel Technique for One-Stage Reconstruction of Persistent Scalp Necrosis.

Background:  Cranioplasty can be a challenging procedure in certain patients, such as those with scalp necrosis, or when performed after multiple surgical procedures. Herein, we present a patient in whom a part of the skull was placed inside out in a setting where the scalp wound could not be simply sutured because of multiple previous operations.

Methods:  A 66-year-old patient with a history of multiple craniotomies to resect an intracranial tumor suffered significant skin flap necrosis after harvesting the superficial temporal artery for a bypass intending to ligate the internal carotid artery. He subsequently underwent a one-stage reconstruction surgery, in which the central part of the bone was excised, turned over, and fixed at the inner plate of the bone flap on the outside, and the outer plate on the inside.

Results:  This technique reduced the skin tension and reduced the epidural dead space, allowing skin flap healing with acceptable cosmetic results.

Conclusion:  "Inside out cranioplasty" is a valid option for one-stage reconstruction in the cases with scalp necrosis.