title: Scalp reconstruction: a review of the literature and a unique case of total craniectomy in an adult with osteomyelitis of the skull.
abstract: OBJECTIVE
  Osteomyelitis of the skull is a rare condition that can lead to systemic illness, bone loss, intracranial complications, and mortality. Osteomyelitis of the skull typically presents as the boney invasion of an overlying infection of the scalp or sinuses, and it is typically treated with antibiotics and proper wound care. Surgical debridement of the affected bone in the form of a craniectomy may be initiated to stop the progression of the infection when antibiotics fail and the underlying bone becomes grossly eroded.
  
  
  METHODS
  The authors present the case of a 54-year-old woman who required a total craniectomy after developing full-thickness osteomyelitis. A free omental flap along with dermal grafts and split-thickness skin grafts were utilized for soft tissue coverage. A semi-rigid helmet was used to provide durable protection to the brain.
  
  
  RESULTS
  Omental free flap with skin graft coverage provided this patient with durable and long-term soft tissue coverage for a total craniectomy defect, as well as the ability to regain mental status.
  
  
  CONCLUSIONS
  Many factors must be analyzed when approaching composite defects of the scalp. Modality of treatment must be customized to the individual, and the decisions should be based on whether the defect is composed of soft tissue, bone or both, its size, etiology, and presence of a cerebral spinal fluid leak. The goals of treatment are restoration of durable soft tissue coverage, protection of vital underlying structures and control of cerebral spinal fluid leaks.
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of Louisville, Louisville, Ky.
authors.forename: John P
authors.initials: JP
authors.lastname: Tutela
authors.affiliation: School of Medicine, University of Louisville, Louisville, Ky.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Banta
authors.affiliation: School of Medicine, University of Louisville, Louisville, Ky.
authors.forename: Travis G
authors.initials: TG
authors.lastname: Boyd
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of Louisville, Louisville, Ky.
authors.forename: Sean S
authors.initials: SS
authors.lastname: Kelishadi
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of Louisville, Louisville, Ky.
authors.forename: Saeed
authors.initials: S
authors.lastname: Chowdhry
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of Louisville, Louisville, Ky ; Department of Otolaryngology, University of Louisville, Louisville, Ky.
authors.forename: Jarrod A
authors.initials: JA
authors.lastname: Little
keywords: cranium; omental free flap; scalp reconstruction; skull osteomyelitis; total craniectomy