Innovative Removal of Non-Marginally Exposed Hardware From the Frontal Region With Successful Wound Closure

Titanium mesh is a common material for cranioplasty, but postoperative mesh exposure with infection poses a significant challenge-particularly for small, non-marginal defects where traditional instruments are ineffective.

A 41-year-old female developed an infected, non-marginal titanium mesh exposure in the frontal region 60 days after implantation, which followed traumatic brain injury surgery.

Open craniocerebral injury; open frontal bone fracture; focal cerebral contusion and laceration; status post-cranioplasty with titanium mesh; and exposure of frontal titanium mesh complicated by skin infection.

An innovative approach was used: (1) A dental high-speed handpiece (tungsten steel burr) was used to precisely resect the exposed mesh; (2) Negative pressure wound therapy was administered to promote granulation tissue formation; (3) A thin skin graft, harvested from the scalp, was transplanted in a second-stage procedure.

The skin graft survived completely, with rapid healing at the donor site and no visible scarring. The wound closed fully, the infection resolved, and the aesthetic outcome was satisfactory.

For small, non-marginal titanium mesh exposure, the dental high-speed handpiece is an effective resection tool. When combined with scalp skin grafting, this protocol provides a simple, effective, and cosmetically favorable solution.