Vascularized Bipedicled Pericranial Flaps for Reconstruction of Chronic Scalp Ulcer Occurring after Cranioplasty
A 75-year-old woman was diagnosed with subarachnoid hemorrhage and a neurosurgeon performed aneurysmal clipping through a unicoronal incision. Two months later, the patient underwent cranioplasty using the cryopreserved autogenous cranial bone. At the sites of the surgical incision, there was a yellowish pus-like discharge and S. epidermidis was identified. Three weeks after cranioplasty, the wound was closed following incision and drainage. Due to tension at the suture sites, however, ischemic necrosis of the flap margin occurred. Conservative management did not improve wound healing. On physical examination, the patient had full-thickness skin defects 12 mm×10 mm in size on the scalp, accompanied by focal osteomyelitis (). Twelve weeks after cranioplasty, under local anesthesia, we removed all the dirty granulation tissues located in the dead space under the grafted cranial bone, after bone shaving. One week after debridement, under general anesthesia, we reconstructed the chronic ulcer using a bipedicled pericranial flap where the posterior auricular artery and the left superficial temporal artery served as a pedicle. The patient had a satisfactory treatment outcome, without any notable problems during an 11-month postoperative follow-up period.