Innovative Removal of Non-Marginally Exposed Hardware From the Frontal Region With Successful Wound Closure.

Abstract

<h4>Rationale</h4>Titanium mesh is a common material for cranioplasty, but postoperative mesh exposure with infection poses a significant challenge-particularly for small, non-marginal defects where traditional instruments are ineffective.<h4>Patient concerns</h4>A 41-year-old female developed an infected, non-marginal titanium mesh exposure in the frontal region 60 days after implantation, which followed traumatic brain injury surgery.<h4>Diagnoses</h4>Open craniocerebral injury; open frontal bone fracture; focal cerebral contusion and laceration; status post-cranioplasty with titanium mesh; and exposure of frontal titanium mesh complicated by skin infection.<h4>Intervention</h4>An innovative approach was used: (1) A dental high-speed handpiece (tungsten steel burr) was used to precisely resect the exposed mesh; (2) Negative pressure wound therapy was administered to promote granulation tissue formation; (3) A thin skin graft, harvested from the scalp, was transplanted in a second-stage procedure.<h4>Outcomes</h4>The skin graft survived completely, with rapid healing at the donor site and no visible scarring. The wound closed fully, the infection resolved, and the aesthetic outcome was satisfactory.<h4>Lessons</h4>For small, non-marginal titanium mesh exposure, the dental high-speed handpiece is an effective resection tool. When combined with scalp skin grafting, this protocol provides a simple, effective, and cosmetically favorable solution.