Scalp Reconstruction Using Microvascular Free Tissue Transfer in the Patients with Intracranial Antibiotic-Resistant Bacteria Infection

Purpose: When scalp infection occurs after craniectomy and cranioplasty, it tends to be recurrent and fatal. The infection can spread to the underlying tissue when the skull is not present to act as a barrier, eventually leading to epidural abscesses and encephalitis. In such cases of widespread infection, reconstruction of scalp and skull defect after surgical debridement of infected tissue is a great challenge for plastic and neurosurgeons.Methods: Six patients with infection of forehead, scalp, and underlying dura were referred to our clinic for the control of repeated infection. Features and duration of infection, the presence of foreign bodies, bacterial culture tests, types of free flaps, and postoperative complications were investigated.Results: All cases were intracranial infections after neurosurgery and the duration of infection was 4.3±2.6 months. Foreign bodies (artificial bone, titanium mesh, plate, and screw) were present in three cases. Antibiotic-resistant bacteria were cultured in five cases (methicillin-resistant Staphylococcus aureus, methicillin-resistant coagulase-negative staphylococci, carbapenem-resistant Acinetobacter baumannii). For the control of infection, removal of foreign body and free tissue transfer was performed. The infection was controlled successfully during follow-up periods (59.3±42.0 months). Conclusion: Intracranial infections after neurosurgery on the skull can be fatal and lead to long-term sequelae. For the control of intracranial infection with antibiotic-resistant bacteria, well-vascularized free tissue transfer followed by foreign body removal is recommended. After infection control through free tissue transfer, secondary operations such as cranioplasty with titanium mesh or fat injection can be performed safely without recurrence of infection.