Composite skull and dura defect reconstruction using combined latissimus dorsi musculocutaneous and serratus anterior muscle-rib free flap coupled with vascularized galea transfer: A case report

Recalcitrant epidural abscess following cranioplasty is a complicated problem, which becomes even more trying when large span of dura and skull bone are being replaced by alloplastic materials. A 22-year-old male underwent right fronto-temporo-parietal craniectomy and duroplasty with artificial dura graft after traumatic brain injury. Epidural abscesses recurred after cranioplasty with autologous bone graft as well as with a methyl methacrylate bone plate. The massive defects of both the dura and skull bone (15 × 9 cm) caused by radical debridement were reconstructed successfully with a combined free latissimus dorsi and serratus anterior myo-osseous flap transfer plus galea flap transposition. Proper contour and adequate stability of the construct were maintained during 2-year follow up without episodes of relapsing infection.