Simple is Best: Direct Skin Grafting of Dura After Radical Debridement of Frontal Osteomyelitis

Frontal defects with chronic implant infection, calvarial osteomyelitis, and dural exposure are difficult to reconstruct. A 54-year-old man presented with chronic purulent frontal wounds and exposed cranial hardware after previous fracture fixation. After combined neurosurgical and plastic surgical debridement, all hardware and infected bone were removed. Bilateral supratrochlear-based forehead flaps covered viable exposed calvarium. Two adjacent residual defects over intact, fibrotic, visibly vascular dura were covered directly with a split-thickness skin graft. Fibrin sealant was used to improve graft-bed contact and reduce fixation sutures over the dura. At 6 weeks, the reconstruction remained stable without wound-related or neurological complications. This case supports a recipient-bed-based salvage strategy after complete source control: vascularized tissue for exposed calvarium and direct skin grafting for small areas of intact vascular dura when more complex reconstruction is undesirable.