Using the Reversed Temporal Island Flap to Cover Small Forehead Defects from Titanium Mesh Exposure After Cranial Reconstruction

Skin ulcers and alloplastic implant exposure are intractable complications that arise after cranial defect reconstruction. Many methods have been used to repair these defects, including skin grafting, local flaps, and free flaps; however, in most cases, alloplastic implants must be removed to control infections. Here, we describe the use of a reversed temporal island flap to repair exposed titanium mesh without removing it.Eight cases of skin and titanium mesh exposure were included from 2010 to 2015. A preauricular flap pedicled on the reversed superficial temporal artery was designed to repair forehead defects. The titanium mesh was retained, resterilized, and reimplanted.Flaps were survived completely, and the titanium meshes were reimplanted with no complications. The results were aesthetically and functionally sufficient, with minimal donor-site morbidity in all cases during the 10- to 24-month follow-up period.The described method is easy to design and perform. The flap has a reliable blood supply to help fight infection. The titanium mesh is preserved completely, avoiding a second cranioplasty.