Staged scalp soft tissue expansion before delayed allograft cranioplasty: A technical report

BACKGROUND:: Hemicraniectomy is an established neurosurgical procedure. However, before cranial vault reconstruction, it is imperative that sufficient scalp soft tissue is available for coverage of the reconstructed skull. OBJECTIVE:: To present 2 complex cases of posttraumatic patients requiring soft tissue expansion of the scalp before definite cranioplasty with use of a synthetic polyethylene graft. METHODS:: Two patients underwent decompressive hemicraniectomy for trauma and required delayed cranioplasty. Both patients had developed significant scalp contraction and presented with a paucity of soft tissue. These patients underwent a staged cranioplasty in which we first achieved scalp-tissue expansion adjacent to the craniectomy site over a prolonged interval. In a second stage, the patient underwent definite reconstructive surgery in which the subgaleal expanders were removed and polyethylene allograft cranioplasty was performed. RESULTS:: Cutaneous coverage of the underlying defect could be achieved in this setting without causing tension on the incision line secondary to the now available excess scalp tissue. CONCLUSION:: Repair of a cranial defect requires detailed attention to the available scalp and its size relationship to the skull defect to achieve a successful outcome with an aesthetically pleasing, reliable, and lasting result. Preoperative scalp tissue expansion is a valuable step in taking care of patients presenting with scalp soft tissue defect. This technique reduces the morbidity associated with conventional rotational and free-flap techniques.