Pre-Cranioplasty Correction of Dural Depression Using Negative Pressure Wound Therapy in an Infected Cranial Defect: A Case Report of a Novel Approach

We report a case of extensive cranial bone and scalp defects with dural depression following decompressive craniectomy that was successfully managed with staged reconstruction using negative pressure wound therapy (NPWT) and a custom-made artificial bone implant. Initially, NPWT was applied to the temporary artificial bone to accelerate granulation tissue formation and to improve dural depression. Continuous NPWT led to the correction of the dural depression and preparation of the wound bed. Definitive reconstruction was subsequently performed using another custom-made artificial bone and free combined serratus anterior and latissimus dorsi musculocutaneous flap. The patient's postoperative course was uneventful, with no wound-related complications. This case highlights the utility of NPWT not only for wound bed preparations, but also for the correction of dural depression, offering a favorable surgical environment for complex cranial reconstruction. A combined approach using NPWT and custom-made cranial implants should be considered as an effective strategy for managing large cranial defects.