Repetitive Exposure of Titanium Mesh after Cranioplasty: A Case Report

Abstract

Cranial defects are often managed with cranioplasty, where synthetic substances are still extensively used despite the advantages of using biological materials. Among the complications of cranioplasty, skin defects with implant exposure are the most common, with a particularly high incidence when titanium mesh is used. This is a case report of a 32-year-old patient who underwent cranioplasty with titanium mesh. After 2 years, a forehead skin defect with mesh exposure occurred, onto which a latissimus dorsi free flap was applied without removing the mesh. Ten months later, the patient was consulted for another skin defect, and a second latissimus dorsi free flap was applied with near-total mesh removal. After 6 months, another cranioplasty with hydroxyapatite bone cement and flap modification was performed. Lastly, revision surgery with complete removal of the mesh remaining in the right eyebrow was executed after 1 year, and no major complications were seen during the 4 months of follow-up. Through this experience, we suggest that skin defects with mesh exposure need to be managed with total removal of the metal material, followed by cranioplasty using another material and appropriate soft tissue coverage over the reconstructed cranium.