Head Skull damaged

Thank you in Advance for any information.

My brother is 22 years old man who underwent decompressive right front parietal craniotomy for a sever head injury (car accident) in June 2004. Therefore, the right half of his head skull was removed. After one month recovery, the bone flap was replaced in July 2004 and he was making an uneventful and satisfactory recovery. After few weeks, the bone flap got damage and removed again and disposed.

Now, what is the best treatment/solution for repairing the defect skull to replace the damaged bone flap?
When is the good time to do that? Bear in mind that his bone flap was removed in September 1st.

Thank you once again.

[CCF-Neuro-M.D.-CS]

Without knowing the specifics of your brothers case I cannot recommend a specific therapy or time line. In general terms, you want to allow time for the area where the bone flap was removed to heal and be clear of infection. This typically is around 6 months. After that an artificial cover can be placed. There are three choices, the first choice is an acrylic flap made custom for the opening, the second involves placing a wire mesh and then a "cement" material over that, and last is a metal "plate". Again the choice of material depends on the specifics of the case. You should discuss these options with your surgeon. Good luck.