Patient Question:Disease:Titanium cranial bone exposed and two failed flap surgeries. Description of disease:About two years ago, I had a cranial injury in a car accident, and I had a titanium cranial patch at the right frontal temporal area, and then I slowly recovered well. However, six months ago, the skin at the forehead where the titanium mesh was patched became thin and atrophied, and the color became green (the green color should be the color of the titanium mesh). We went to a regular hospital and the doctor did two flap transfer surgeries to prevent the titanium mesh from being exposed. The first flap transfer near the skin atrophy was unsuccessful, and the second flap transfer between the abdomen and thigh was successful, but the skin thinned again after one month, and then it developed into the current titanium mesh exposure, and the exposed area kept increasing. Some doctors suggested taking the titanium mesh and others suggested trying another flap graft. But the flap graft has already failed twice, and according to the local doctors, there are no more good flaps left, so we are afraid that the flap graft will fail again, but we are afraid that taking the titanium mesh will hurt more. I would like to ask you for help: 1) Have you ever received similar cases and do you have any solutions? 2) What is the success rate of flap treatment without taking the titanium mesh? The treatment of cranial titanium mesh exposure: Titanium mesh is a relatively common method for treating cranial defects, but in fact, there are quite a lot of failed cases, and many cases that come to me are the same as yours. which eventually could not be blocked. After more than ten years of experience and dealing with hundreds of cases of exenteration, we have summarized the following experience. Once the exfoliation starts, it means that the body is not adapted to titanium, no matter how expensive the material is, it is not worth to treat conservatively. The best way is to step 1, remove it firmly and heal the wound with scalp implants as soon as possible. Step 2, use expander to repair the scar, this is very important, the artificial material under the scar is easily exposed. Step 3, custom-made artificial bone and other non-titanium type materials. This way all the wounds are in the head and the safety factor is high. Always keep in mind that multiple small surgeries are safer and more reliable than one large surgery, and that simple methods are always better than complex ones. This is the fundamental reason why microdermal flaps have become less and less common over the years.