Cranial reconstruction ranges from skin-only reconstruction to reconstruction of skin-soft tissue and bone complexes. Reconstruction goals include protection of brain tissue, prevention of lethal complications, and cosmetic appearance. We retrospectively reviewed the functional and cosmetic results of our two-stage reconstruction cases using free vascularized tissue grafts and artificial bone substitutes for extensive cranial and skin defects due to infection after post-craniotomy cranioplasty. We enrolled three patients, ranging in age from 37 to 79 years. The patients underwent hard tissue reconstruction with artificial bone substitutes after a certain period following debridement of infected tissue and free anterolateral thigh flap transfer between May 2017 and May 2022. All patients had no postoperative complications such as infection and sinking skin flap syndrome. The hydroxyapatite implants used for hard tissue reconstruction have been reported as highly resistant to infection, and we found no infections in our reconstruction cases. From the previous studies and our own experiences, we believe that our two-stage reconstruction strategy is suitable for post-cranioplasty infection in terms of the low risk of infection recurrence, availability of well-tailored artificial bone substitutes, and possibly a better cosmetic result.
