Innovative technique to cover exposed dura mater after occipital osteomyelitis, using our triple layer using...

Reconstructing a large, full-thickness cranial defect caused by trauma, with exposed dura mater, can be very challenging when using free or regional flaps. The wide current international practice is to employ either free flaps in fit patients or regional flaps in the form of Dermal Regeneration Templates (DRTs) in unfit patients, which can provide an alternative solution to flap surgery. In our study, we developed a new three-layer technique using a single-stage salvage procedure that combines Matriderm® dermal substitute (MedSkin Solutions Dr. Suwelack AG, Germany), galea rotation flap, and single pedicle fasciocutaneous transposition flap, which helps avoid complications associated with free flaps, such as microvascular-related thrombosis, pedicle twisting, and flap necrosis. We have covered the donor site with Matriderm® and a split-thickness skin graft (STSG). We here report the case of a 35-year-old male with post-traumatic occipital osteomyelitis, with scarring alopecia. In our new techniques, we employed a three-layer, single-stage salvage procedure, resulting in satisfactory functional and aesthetic outcomes and patient satisfaction while avoiding the time and complications of free flaps in medium-sized defects.