case_images: PMC8247695_01
case_images: A 54-year-old female presented with gangrenous soft tissues over the forehead following an extensive polytrauma.
case_images: SNI-12-248-g001.jpg
case_images: PMC8247695_01_SNI-12-248-g001.jpg
case_images: F1
case_images: Under sedation and local anesthesia, necrotic areas were debrided along the demarcation margins, resulting in a 10 cm x 6.5 cm forehead and scalp defect, including 9 cm x 5 cm area of barren skull bones without any periosteal cover [Figure 1].
case_images: Debridement along demarcation margins was followed by trephination of the outer skull bones (black arrows).
case_images: SNI-12-248-g002.jpg
case_images: PMC8247695_01_SNI-12-248-g002.jpg
case_images: F2
case_images: Outer vault of the skull was trephined at least 1 cm apart until punctate bleeding was visible from the underlying diploe [Figure 2].
case_images: An absorbable bi-layered polyurethane biomaterial was sutured onto the forehead defect sized 65 cm2 under minimal anesthesia.
case_images: SNI-12-248-g003.jpg
case_images: PMC8247695_01_SNI-12-248-g003.jpg
case_images: F3
case_images: Temporising Matrix; PolyNovo Ltd., Australia) was placed over the defect and sutured in place [Figure 3]. The patient remained comfortable during the entire procedure, barely feeling any pain or discomfort, and was discharged the next day.
case_images: 2 weeks later, granulation ingrowth was observed within the scaffold overlying the periosteum (white arrow), while the scaffold overlying the bone was avascular (black arrow).
case_images: SNI-12-248-g004.jpg
case_images: PMC8247695_01_SNI-12-248-g004.jpg
case_images: F4
case_images: She was followed up weekly when gradual tissue regeneration was visible within the scaffold [Figure 4].