• Marcelo D Vilela, Hugo A S Pedrosa, Felipe D Sampaio, and Junia L Carneiro.
• Neurosurgery, Mater Dei Hospital, Belo Horizonte, Minas Gerais, Brazil; Neurological Surgery, University of Washington, Seattle, Washington, USA. Electronic address: vilelamd@gmail.com.
• World Neurosurg. 2018 Feb 1; 110: 30-34.

BackgroundManagement of encephaloceles is challenging when massive brain herniation is present. In such instances, an expansile cranioplasty may be attempted so as to preserve some herniated brain tissue. Complications such as wound dehiscence, cerebrospinal fluid leak, and scalp necrosis are postoperative concerns. The treatment of scalp necrosis with dural and brain exposure is certainly a challenge due to the complexity of flap techniques in such a young age. Herein we describe the use of a novel technique for the management of a scalp necrosis and dehiscence in an infant.Case DescriptionA patient with a giant parietal encephalocele and massive brain herniation underwent an expansile cranioplasty. A large scalp necrosis ensued as a complication and later progressed to a suture dehiscence despite a new surgical intervention, with resultant brain exposure. A scalp reconstruction was subsequently performed using an artificial dermal substitute, laid directly onto the brain, followed by a split-thickness skin graft. We observed a rapid engraftment, without any further complications, with an acceptable cosmetic result in the long-term follow-up.ConclusionA simple technique, such as the use of an artificial dermal matrix with simultaneous split-thickness skin graft, may be an effective treatment for the repair of scalp defects, even when coverage of exposed brain tissue is necessary, when no other techniques are found to be suitable.Copyright © 2017 Elsevier Inc. All rights reserved.

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