Vascularized Bipedicled Pericranial Flaps for Reconstruction of Chronic Scalp Ulcer Occurring after Cranioplasty
A 25-year-old man was diagnosed with subdural hemorrhage and underwent decompression via a pterional approach by a neurosurgeon. When his symptoms improved, the patient underwent cranioplasty using the cryopreserved autogenous cranial bone. The ulcer occurred along the incision line. Despite being treated with ambulatory treatments, it had still not healed at postoperative four months. At the time of the outpatient visit, the patient presented with full-thickness scalp defects 20 mm×10 mm in size, where the discolored bone was exposed. In addition, the hair and follicles were also exposed in the subcutaneous layer adjacent to the ulcer (). After identifying methicillin-resistant Staphylococcus aureus, the patient received nine days of pre-treatment. Following the resection of the ulcer and the adjacent scar tissue, there was a discoloration in the overall layer of the grafted calvarial bone. We removed this layer, including its inner table. By using the left occipital artery, the right supraocular artery, and the supratrochlear artery as a pedicle, we performed a bipedicled pericranial flap. In addition, we elevated a unipedicled pericranial flap, where the superficial temporal artery served as a pedicle, to cover the defects after the removal of the cranial bone. Until postoperative four months, the patient had good aesthetic outcomes without developing any notable complications.