PMC8247695_01
A 54-year-old female presented with gangrenous soft tissues over the forehead following an extensive polytrauma.
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F1
Under sedation and local anesthesia, necrotic areas were debrided along the demarcation margins, resulting in a 10 cm x 6.5 cm forehead and scalp defect, including 9 cm x 5 cm area of barren skull bones without any periosteal cover [Figure 1].
Debridement along demarcation margins was followed by trephination of the outer skull bones (black arrows).
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F2
Outer vault of the skull was trephined at least 1 cm apart until punctate bleeding was visible from the underlying diploe [Figure 2].
An absorbable bi-layered polyurethane biomaterial was sutured onto the forehead defect sized 65 cm2 under minimal anesthesia.
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F3
Temporising Matrix; PolyNovo Ltd., Australia) was placed over the defect and sutured in place [Figure 3]. The patient remained comfortable during the entire procedure, barely feeling any pain or discomfort, and was discharged the next day.
2 weeks later, granulation ingrowth was observed within the scaffold overlying the periosteum (white arrow), while the scaffold overlying the bone was avascular (black arrow).
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F4
She was followed up weekly when gradual tissue regeneration was visible within the scaffold [Figure 4].