PMC6720993_01
Change in shape of a pinwheel-shaped titanium mini plate. (a) A titanium plate that had been inserted during cranioplasty 16 years previously is protruding from the scalp through a circular defect. (b) Three-dimensional computed tomography (3D-CT) scan image showing that part of the titanium plate has been bent upwards. (c) After surgical removal, the bend in the plate is clearly visible.
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Three weeks after the head trauma, he noticed the plate protruding through his scalp (Figure 1(a)). Three-dimensional computed tomography (3D-CT) scan revealed that part of the titanium plate had been bent and was penetrating the skin (Figure 1(b)). The plate was removed and the skin defect repaired.  Figure 1(c) shows the removed plate and the bend in it.
Surgical treatment. (a) A skin incision has been made above the titanium plate to expose it. (b) The plate and all screws have been removed. (c) A relief skin incision has been made 6 cm posterior to the skin defect to enable (d) suturing of the defect without causing tension (white arrow). (e) The scalp defect caused by the relief incision portion has been covered with skin graft from the outer layer of skin of the right thigh. (f) Two months after the surgery, the skin incision has healed without infection and the skin graft has been successfully incorporated.
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Under general anesthesia, a skin incision was made along the plate to expose it (Figure 2(a)), and then the plate and screws were completely removed (Figure 2(b)). After debridement around the skin defect, a relief skin incision was made 6 cm posterior to it (Figure 2(c)) to enable suturing of the defect portion without causing tension (Figure 2(d), arrow). The relief skin incision portion was covered with a graft from the outer layer of the skin of the right thigh (Figure 2(e)). Two months later, the skin incision had healed without infection and the skin graft had been successfully incorporated (Figure 2(f)).