Staged reconstruction of infected dura mater using vascularized rectus abdominis muscle

Alloplastic synthetic dura is widely used in dura mater reconstruction. Although the incidence of postoperative alloplastic dura infection is not common, the possibility of intractable postoperative wound infection despite appropriate antibiotic use exists. Rectus free flap is composed of well-vascularized muscle and fascial tissues. This flap is appropriate for volumetric replacement in large defects, whereas the fascia is appropriate for dura mater reconstruction. We report a case of successful reconstruction in a patient who had intractable postsurgical wound infection with staged operation using vascularized rectus muscle and fascial flap in a patient with meningioma reconstructed with alloplastic dura graft (Neuropatch; B. Braun Melsungen AG, Melsungen, Germany) and additionally achieved aesthetic results. In the first step, vascularized rectus fascia and muscle were transferred to contaminated reconstructed dura after craniectomy. The removed calvarial bone was banked to the abdominal donor-site pocket after cleansing. Finally, in the second stage, cranioplasty was performed with the banked autologous calvarial bone.