Mesh-graft duraplasty using autologous fascia lata for reconstruction of a large infected cranial dural defect: Technical note

Background Duraplasty is a critical step in neurosurgical procedures. Reconstruction of large dural defects may be challenging when the amount of available autologous tissue is limited, particularly in an infected surgical field. We describe a technical modification in which autologous fascia lata is mechanically meshed to increase its dimensions for cranial dural reconstruction. Methods A 24-year-old male with a previous decompressive craniectomy and synthetic duraplasty developed an intracranial infection after cranial reconstruction with a porous hydroxyapatite implant. The implant and synthetic dural substitute were removed, the infected collection was evacuated, and duraplasty was performed using autologous fascia lata mechanically meshed with a 1:1.5 dermacarrier. The graft was sutured to the dural margins and reinforced with fibrin sealant. Cultures identified Staphylococcus aureus , and targeted antimicrobial therapy with co-trimoxazole and rifampicin was administered for 12 weeks. After radiological resolution of the infection, planned delayed cranioplasty was performed six months later. Results The postoperative course was uneventful and no clinically evident postoperative CSF leakage was observed. At reoperation six months later, a vascularized fibrous layer covered the reconstructed region. Delayed cranioplasty was subsequently performed, and follow-up to five years showed no reported delayed complication related to the cranial reconstruction. Conclusions Mesh-graft duraplasty using autologous fascia lata represents a simple and effective technique for reconstruction of large dural defects, particularly in infected settings where synthetic substitutes are contraindicated. This case demonstrates the technical feasibility of mechanical meshing of autologous fascia lata to increase graft dimensions for reconstruction of a large cranial dural defect in an infected surgical field. Further clinical experience is required to determine the safety, reproducibility, and clinical outcomes associated with this technique.