Vascularized Bipedicled Pericranial Flaps for Reconstruction of Chronic Scalp Ulcer Occurring after Cranioplasty
A 56-year-old woman was diagnosed with a subdural hemorrhage. The patient underwent decompression through an S-shaped incision at the parietal region. When her symptoms improved, the patient underwent cranioplasty using methylmethacrylate. Six months after cranioplasty, the patient presented to our clinic with multiple ulcers 5 mm×5 mm in size, where both the skull and the bone-plate fixation system were exposed along the incision line (). The scalp was also very thin along the incision line. A bacterial culture test was performed at the margin of the ulcer, which identified S. aureus and S. epidermidis.\nAfter seven days of preoperative treatment, the thinned skin, the ulcer, the adjacent inflammatory tissue, and the metal plate were removed under general anesthesia. We shaved off some discolored bony structures with osteomyelitic changes, including the outer table of the calvarial bone and bone prosthesis. Then we used a bipedicled pericranial flap where the left occipital artery and the right superficial temporal artery served as pedicles. The surgery was successful without any notable complications during a six-month postoperative follow-up period.