Cranial defects are rarely created by patients in the process of chronic psychotic illnesses. Penetration of foreign objects into the brain with resultant infection may follow even after minor head-penetrating wounds.2
Our patient had an infected lesion affecting scalp, cranium, and brain tissue caused by continuous digging. Treatment of brain abscess involves removing the source of infection, draining the brain abscess, and administering culture-directed intravenous antibiotics therapy.3Staphylococcus aureus is the most common isolated pathogen, and antibiotics therapy for a total of 6–12 weeks should be applied. Debridement of devitalized tissue may be necessary to control infection, to improve healing, or to prepare the base for reconstruction.4 Repair of cranial defects, especially when infected, presents generally with apparent difficulty. After this goal is achieved, reconstruction and repair of cranial and scalp defect can be performed in a stepwise fashion.5
Our surgical treatment had two sessions including early debridement of necrotic tissues and fasciocutaneous rotational flap to cover the area. Another advantage of this flap is that they are highly vascularized, providing delivery of adequate amount of antibiotics to the infected area.
In conclusion, surgical treatment should be performed in two separate sessions.