Fate of free muscle transfer covering chronically infected burned skull

This case report describes a 28-year-old male who sustained a 46,000-V cranial electrical injury that resulted in devascularization, necrosis, and secondary infection of the skull despite bone coverage with a free muscle transfer. In the face of osteomyelitis of the skull, the free muscle transfer and the brain were not compromised. A review of the literature and this case reinforce the practice of leaving the skull in place and covering it with vascularized tissue. Resection of the infected skull and later replacement with alloplastic material were curative.