Scalp Reconstruction

A Review of the Literature and a Unique Case of Total Craniectomy in an Adult With Osteomyelitis of the Skull

John P. Tutela, MD; Jonathan C. Banta, BS; Travis G. Boyd, MD; Sean S. Kelishadi, MD; Saeed Chowdhry, MD; Jarrod A. Little, MD


ePlasty. 2014;14 

In This Article


We report the unique case of a 54-year-old woman who required a total craniectomy after developing full-thickness osteomyelitis of the entire cranium due to a scalp lesion obtained less than 1-year prior. Although surgical debridement of necrotic bone and the use of antibiotics is a well-documented treatment for skull osteomyelitis, the large extent of this particular infection dictated an equally large debridement. Cranial reconstruction using an omental free flap with split-thickness skin grafts was successful in providing soft tissue coverage while a helmet provided rigid protection. The patient regained preinjury neurologic function and remains free of infection.

Skull osteomyelitis is a rare and potentially fatal affliction that necessitates prompt diagnosis and treatment with surgical debridement and antibiotics. Early suspicion and recognition of the specific organism causing this treatable condition is key to the patient's prognosis. The goals of treatment are control of infection restoration of durable soft tissue coverage, protection of vital underlying structures, and control of cerebral spinal fluid leaks.