Romero, Flávio Ramalho [UNESP]Zanini, Marco Antonio [UNESP]Ducati, Luis Gustavo [UNESP]Gabarra, Roberto Colichio [UNESP]2014-05-272014-05-272013-10-14International Journal of Surgery Case Reports, v. 4, n. 11, p. 1007-1009, 2013.2210-2612http://hdl.handle.net/11449/76835INTRODUCTION Sinking skin flap syndrome or syndrome of the trephined is a rare complication after a large craniectomy, with a sunken skin above the bone defect with neurological symptoms such as severe headache, mental changes, focal deficits, or seizures. PRESENTATION OF CASE We report a case of 21 years old man with trefinated syndrome showing delayed dysautonomic changes. DISCUSSION Our patient had a large bone flap defect and a VP shunt that constitute risk factors to develop this syndrome. Also, there is reabsorption of bone tissue while it is placed in subcutaneous tissue. The principal symptoms of sinking skin flap syndrome are severe headache, mental changes, focal deficits, or seizures. Our patient presented with a delayed dysautonomic syndrome, with signs and symptoms very characteristics. Only few cases of this syndrome were related in literature and none were presented with dysautonomic syndrome. CONCLUSION We reported here a very uncommon case of sinking skill flap syndrome that causes a severe dysautonomic syndrome and worsening the patient condition. © 2013 The Authors.1007-1009engDysautonomic syndromeSinking skin flap syndromeTrefinatedArtigo10.1016/j.ijscr.2013.08.013Acesso aberto2-s2.0-848851492102-s2.0-84885149210.pdf28949751418951896664825590096912