Objective:

To present a new three-layer technique for reconstructing large cranial defects with exposed dura mater in a patient with occipital osteomyelitis.

Approach:

Key Findings:

• The three-layer approach resulted in satisfactory functional and aesthetic outcomes.
• The patient reported high satisfaction and no neurological deficits three years post-operation.
• The method avoids complications associated with free flaps.

Interpretation:

The innovative technique provides an effective alternative for patients unfit for free flap surgery.

Limitations:

• The study is based on a single case report, limiting generalizability.
• Long-term outcomes beyond three years are not assessed.

Conclusion:

The three-layer approach may be considered for reconstructing cranial defects with exposed dura mater in patients with high surgical risk.

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