Repair of a Scalp Defect with Punctate Skull Fenestration and Skin Grafting

Reconstructing scalp defects can be challenging for a plastic surgeon. For this purpose, different procedures such as primary repair and coverage with skin grafts or flaps can be considered. Sometimes, the external table of the skull can be removed completely to the diploic space. At the same time or after the formation of granulation tissue, the diploic space can be covered with split-thickness skin grafting.
In this article, we have reported the reconstruction of a traumatic scalp defect in a one-year-old baby. There was a large defect in the left temporoparietal area of the scalp. The wound was debrided and irrigated with normal saline frequently. After the wound infection was controlled, instead of covering it with a flap or excising the external table of the skull and skin grafting, we managed this defect by the fenestration of the external table of the skull followed by the formation of the granulation tissue and coverage of the defect with split-thickness skin grafting. The post-op course was uneventful, and the wound was covered completely with the skin graft. We believe that this method of treatment in a child allows us to provide better coverage for the defect when the patient is older and after tissue expansion. We also showed that the punctate fenestration of the skull can provide a granulated tissue bed for skin grafting, as well as the excision of the external table of the skull.