Go digital! The surgeon's finger as a digital shield for dura in cranial defects in repeat craniofacial surgery

Calvarial bone gaps are commonly encountered in craniofacial surgery, particularly in syndromic craniosynostosis and secondary bone pathology, with exposed or adherent dura increasing the risk of injury during subperiosteal dissection. We describe a simple, reproducible technique-digital shielding-using the surgeon's gloved finger as a dynamic protective interface for the dura while enabling controlled circumferential dissection around calvarial bone defects. We present a 4-year-old child with syndromic craniosynostosis, raised intracranial pressure and multiple calvarial defects with dural adherence encountered during posterior cranial vault remodelling. The technique enabled safe delineation of calvarial bone margins to facilitate osteotomies. The patient was discharged 3 days postoperatively and remains well at 10 weeks. Digital shielding is a simple, no-cost adjunct used safely in our unit for over 30 years.