Cranioplasty can become a challenging procedure in certain patients, such as those with scalp necrosis, or when performed after multiple surgical procedures. Some important steps are essential to achieve reconstruction without complications, including: scalp suture without tension and obliteration of dead space. This procedure requires acceptable cosmetic results; however, reconciling these elements is difficult in clinical practice. Herein, we present a patient in whom these elements were achieved by placing part of the skull inside out in a setting where the scalp wound could not be simply sutured because of multiple reoperations before the reconstruction procedure. A 66-year-old patient with a history of multiple craniotomy operations to resect an intracranial tumor suffered significant skin flap necrosis after the procedure harvesting the superficial temporal artery for a bypass intending to ligate the internal carotid artery. He subsequently underwent one-stage reconstruction surgery, in which the central part of the bone was excised, turned over, and fixed with the inner plate of the bone flap on the outside, and the outer plate on the inside. This technique relaxed skin tension and reduced the endocranial dead space, providing acceptable cosmetic results. Conclusion "Inside out cranioplasty" is a valid option for one-stage reconstruction in cases with scalp necrosis.