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Microvascular anastomosis was performed using the superficial temporal vessels. 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rjaf1042  \n[https://doi.org/10.1093/jscr/rjaf1042](https://doi.org/10.1093/jscr/rjaf1042)  \nCase Report  \nCase Report  \nCoverage of necrosis after secondary cranioplasty using a latissimus dorsi muscle flap  \nJulian Ramin Andresen 1 , *, Wolfgang Happak2 , Magnus Kuess3 , Harald Kurt Widhalm1  \n1 Division of Trauma Surgery, Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria  \n2 Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria  \n3 Department of Neurosurgery, Medical University of Vienna, Vienna, Austria  \n*Corresponding author. University Clinic for Orthopaedics and Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. E-mail: [ramin.andresen@meduniwien.ac.at](ramin.andresen@meduniwien.ac.at)  \nAbstract  \nSecondary cranioplasty aims to restore skull integrity after decompressive surgery but can be complicated by rare issues such as skin necrosis. We report a case of a 70-year-old female with multiple comorbidities who developed extensive scalp necrosis following cranioplasty. Surgical revision revealed significant dural exposure, requiring reconstruction with a free latissimus dorsi flap and a splitthickness skin grafting. Microvascular anastomosis was performed using the superficial temporal vessels. At 8-week follow-up, the site was fully healed without infection or recurrent necrosis. This case underscores the effectiveness of the latissimus dorsi free flap in managing large cranial defects, especially in patients with complex vascular conditions.  \nKeywords: cranioplasty; head injury; musculus latissimus dorsi flap; scalp defect  \nIntroduction  \nSecondary cranioplasty represents a complex and often challenging procedure for the reconstructive surgeon. It is typically performed to correct scalp and cranial defects following a prior craniectomy, which may have been necessary due to traumatic brain injury, hemorrhagic, or ischemic stroke, tumor resection, or congenital cranial deformities [1] . These procedures serve to relieve elevated intracranial pressure and offer neuroprotection, while also aiming to restore the anatomical integrity of the skull [2] .  \nAlthough secondary cranioplasty is generally performed without major complications, cases involving vascular injury during the initial intervention - such as damage to the sinus sagittalis superior-can compromise scalp perfusion and result in rare but serious complications such as skin necrosis.  \nIn cases of intraoperative dual compromise, the latissimusdorsi free flap represents a reliable reconstructive option. This flap has broad applications in reconstructive surgery, including in the head and neck, breast, and trauma settings [3 , 4] .  \nRecent advances include the use of patient-specific,3D-printed implants composed of titanium or polymethylmethacrylate (PMMA), which improve anatomical fit and long-term outcomes [5–7] . These implants can be combined with vascularized tissue flaps to optimize both structural and esthetic results. Long-term studies have demonstrated high patient satisfaction and reduced complication rates with such hybrid approaches [8] .  \nFigure 1. Illustration of a hyperdense, concave 13 mm wide mass as an expression of a subdural hematoma in the right hemispheric region (red arrows) and a consecutive midline shift of 8 mm due to edema (blue arrows) .  \nReceived: November 10, 2025 . Accepted: December 5, 2025  \n© The Author(s) 2026 . Published by Oxford University Press and JSCR Publishing Ltd.  \nThis is an Open Access article distributed under the terms of the Creative Commons Attribution License ([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/)), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.  \nFigure 2. (a) Axial CT image after osteoclastic craniotomy and (","cbCaisd047xfaN6E","https://ap.wps.com/l/cbCaisd047xfaN6E","pdf",1027079,"English","# Abstract\n# Introduction\n# Case report\n## Patient history and presentation\n## Initial assessment\n## Surgical intervention\n## Postoperative course in ICU","[{\"question\":\"What complication does the case describe after secondary cranioplasty?\",\"answer\":\"The case describes extensive scalp necrosis following secondary cranioplasty with subsequent dural exposure.\"},{\"question\":\"How was the dural exposure and scalp defect reconstructed?\",\"answer\":\"Reconstruction used a free latissimus dorsi flap together with split-thickness skin grafting.\"},{\"question\":\"What was the reported outcome at follow-up?\",\"answer\":\"At 8-week follow-up, the reconstructed site was fully healed without infection or recurrent necrosis.\"}]","Coverage of necrosis after secondary cranioplasty using a latissimus dorsi muscle flap | PDF",1790750920]