A simple way to manage a chronic ulcer at the cranioplasty titanium implant exposure site by dermal autograft and platelet-rich plasma

Abstract

Abstract Rationale: Titanium implant exposure is not a rare complication after cranioplasty. Usually, we apply a free flap or local flap for reconstruction. Patient concerns: A 56-year-old male with a medical history of gout, hepatitis and chronic renal disease presented with an ulcer and implant exposure after titanium cranioplasty. The flap around the ulcer was too thin to perform local flap reconstruction. Free flap surgery was rejected by the patient. Diagnoses: The ulcer with implant exposure had little exudate without malodor. The underlying wound had epithelial ingrowth and was 1.5 cm × 0.5 cm in size over the left parietal region of the head. The wound culture was staphylococcus lugdunensis-positive. Interventions: Oral antibiotics and biofilm decontamination were used to manage peri-implantitis for 6 weeks. Dermal autografts were harvested with a thickness of 0.020 inches. A 2 mm wide area of de-epithelization was created around the ulcer margin. Platelet-rich plasma was locally injected into the periwound skin. Outcomes: The patient was followed up by telephone at 9 months postoperatively, and the scar condition was stable without recurrent ulcers. Lessons: Dermal autografts with platelet-rich plasma may serve as an alternative method when a local flap is not feasible and the wound defect is smaller than 1 cm2.