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

Abstract

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.

Keywords

cosmetic result - cranioplasty - dead space - scalp necrosis - scalp reconstruction

Ethical Approval and Consent to Participate

All the procedures in this study were performed in accordance with the 1964 Declaration of Helsinki. A series of treatments were performed after obtaining appropriate written informed consent from the patients. The requirement for additional written consent for inclusion in this study was waived by the Ethics Committee of Saiseikai Shiga Hospital (Permission number: 547) because of the retrospective and observational nature of the study.

Author Contributions

All the authors contributed to the conception and design of the study. Material preparation and data collection were performed by all the authors. Data analysis was performed by Shigeomi Yokoya. The first draft of the manuscript was written by Shigeomi Yokoya, and all the authors commented on the previous versions of the manuscript. All the authors have read and approved the final manuscript.

Publication History

Received: 31 December 2022

Accepted: 07 March 2023

Accepted Manuscript online:
14 March 2023

Article published online:
02 August 2023

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