case_images: PMC10790795_01
case_images: Full-thickness occipital skull defect with circular scar contractures and central exposure of the dura mater (indicated by arrows).
case_images: ICRP_A_2285058_F0001_C.jpg
case_images: PMC10790795_01_ICRP_A_2285058_F0001_C.jpg
case_images: F0001
case_images: Additionally, a large oval skull cap defect with dura mater exposure in the occipital region was observed (see Figure 1). The clinical examination revealed an oval, non-inflammatory scarred area (8.5 x 10 cm) in the high occipital region, painless upon palpation, with beginning scar retractions extending towards the nuchal area and central exposure of the dura mater (see Figure 1).
case_images: Computed tomographic (A and B) and magnetic resonance imaging (C and D) visualization of the skull defect.
case_images: ICRP_A_2285058_F0002_B.jpg
case_images: PMC10790795_01_ICRP_A_2285058_F0002_B.jpg
case_images: F0002
case_images: Morphologically, a 5 x 7 cm scalp defect with chronically thickened dura mater was observed (see Figure 2).
case_images: Field biopsy with the extraction of 12 cutaneous tissue samples from the wound margin.
case_images: ICRP_A_2285058_F0003_C.jpg
case_images: PMC10790795_01_ICRP_A_2285058_F0003_C.jpg
case_images: F0003
case_images: To exclude the possibility of scar carcinoma, a field biopsy was initially conducted, involving the collection of 12 cutaneous tissue samples from the wound margins (see Figure 3).
case_images: Defect coverage using a free myocutaneous latissimus dorsi flap with anastomosis to the right facial artery (intraoperatively). marked with arrows: facial artery and vein (red and blue rubber loops) and marginal mandibular branch of the facial nerve (white rubber loop).
case_images: ICRP_A_2285058_F0004_C.jpg
case_images: PMC10790795_01_ICRP_A_2285058_F0004_C.jpg
case_images: F0004
case_images: Following initial full-thickness debridement, the neurosurgery team performed a complication-free cranioplasty using bone cement (Palacos ; Heraeus Medical GmbH, Germany), and the existing skin-soft tissue defect (23 x 13 cm) was covered by plastic surgeons using a free myocutaneous latissimus dorsi flap, anastomosed to the right facial artery (see Figure 4).
case_images: Postoperative result five weeks after defect coverage with a free myocutaneous latissimus dorsi flap.
case_images: ICRP_A_2285058_F0005_C.jpg
case_images: PMC10790795_01_ICRP_A_2285058_F0005_C.jpg
case_images: F0005
case_images: At the 5-week postoperative follow-up examination, a well-perfused flap with non-irritated wound and scar conditions was observed (see Figure 5).