Palliative Coverage of Cranial Defect following Failed Cranial Flap for Advanced Squamous Cell Carcinoma: Case Report

With advanced-stage head and neck cancers, patients may develop large and/or complex wounds despite multiple reconstruction attempts. Wound coverage may require novel approaches to palliate the patient.

We present the case of a 56-year-old female with advanced squamous cell carcinoma of the scalp and skull who required multiple surgical interventions. Despite our best reconstructive efforts, the patient subsequently developed scalp infection and sepsis, necessitating further debridement for source control. She then required coverage of the exposed dura and skull to prevent further infection.

The calvarial wound was covered with a dermal regeneration template and held in place by a vacuum-assisted closure (VAC) device. This coverage prevented additional infection and morbidity, was relatively easy and comfortable to manage, and demonstrated healing and development of granulation. Unfortunately, the patient succumbed to her systemic cancer before application of a palliative split-thickness skin graft.

A VAC device and dermal regeneration template constituted an excellent modality for managing the complex calvarial wound encountered by otolaryngology, neurosurgery, and burn/wound services. The technique provided appropriate palliation for a patient with advanced head and neck cancer.