We present the case of a 40-year-old female patient who underwent multiple neurosurgical procedures following a severe car accident, including craniectomy, cranioplasty with bone graft, and titanium mesh implantation. However, 8 years later, the patient developed wound dehiscence and left temporal scalp depression, significantly impacting her quality of life.
To address the scalp defect, we implemented a comprehensive treatment approach combining tissue expansion and local flap application. Initially, a tissue expander was implanted during surgery, allowing gradual expansion of the surrounding skin to increase the available scalp tissue. Once sufficient scalp coverage was confirmed, we proceeded with the utilization of local flap techniques, harvesting a local flap from the patient's scalp periphery and transferring it to the defect site for reconstruction. This combined approach of tissue expansion and local flap ensured not only ample scalp coverage but also preserved vascularity and neural integrity.
Following surgery, with appropriate wound care, the patient achieved a satisfactory outcome. The left temporal scalp depression was effectively corrected, and the scalp defect was successfully reconstructed, restoring her confidence and quality of life.
This case underscores the significance of combining tissue expansion and local flap techniques in scalp defect reconstruction, particularly in complex cases. Our experience demonstrates that this treatment modality can provide reliable and long-lasting solutions for patients, aiding them in returning to normal life.

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