Nurse-Led Multidisciplinary Management of Recurrent Cranial Titanium Mesh Exposure After Free Anterolateral Thigh Flap Reconstruction

Cranial titanium mesh exposure is a challenging complication after cranioplasty and may lead to infection, cerebrospinal fluid (CSF) leakage, and soft-tissue defects. The authors report a patient with recurrent cranial titanium mesh exposure and scalp ulcer who underwent removal of the implant and reconstruction using a free anterolateral thigh (ALT) flap. Nursing management focused on intensive free-flap monitoring, infection prevention, CSF leak management, nutritional optimization, and early rehabilitation within a multidisciplinary framework. Hourly assessment of flap color, temperature, and capillary refill was performed during the early postoperative period. A postoperative CSF leak was successfully controlled with lumbar drainage. Targeted antibiotics and meticulous wound care prevented deep infection. The flap survived completely, and the patient regained independent mobility at discharge. This case highlights the important role of nurse-led multidisciplinary management in optimizing outcomes after complex cranial reconstruction.