Full-thickness skin regeneration beneath the exposed titanium mesh in cranioplasty: Two cases report

RATIONALE: Titanium mesh is one of the most widely used implant materials applied in cranioplasty; however, it has been reported to encounter the risk of progressive scalp thinning and implant exposure over time. Here we present 2 cases of exposed titanium mesh (TM) and unusual phenomena of full-thickness skin regeneration beneath the mesh. PATIENT CONCERNS: Two patients, 1 with an 8-year and 1 with a 2-year history of implant exposure after cranial TM implantation. DIAGNOSES: The patients were diagnosed with scalp ulcers and cranial TM exposure. INTERVENTION: The exposed part of the implant was removed, and the full-thickness skin beneath the mesh was directly used as functional soft tissue coverage to repair the scalp defect. OUTCOMES: Full recovery for both patients with cosmetic satisfaction. LESSONS: Though the exact mechanism of this epithelisation phenomenon beneath the TM remains to be elucidated, it provided a feasible choice for clinicians to reconstruct the scalp’s integrity without exerting complicated procedures when dealing with similar cases.