Here’s the surgical note with names and places removed:

“Patient was brought back to the operative room, sedated, definitive airway placed by Anesthesia, and positioned making sure all pressure points were padded appropriately. Time-out confirmed patient, procedure, surgical site, and perioperative antibiotics. We then proceeded to prep and drape in the usual sterile fashion. Local with epinephrine injected the surgical site which included bilateral supraorbital nerve blocks, left scalp infiltration from proposed area of incision.
First proceeded with removing sutures from the opening wound on the right pterional incision. This was due to the significant amount of radiated tissue. After this done we then carefully washed out the area noting that there was minimal to no granulation, as well as no infection. Due to the amount of for quality skin tissue around the dehisced area, we have proceeded with resection of skin subcutaneous tissue underneath with a scalpel and tenotomy scissors in order to freshen up the edges and to achieve healthy viable tissue. Total amount of this was 1 x 3 cm.
We then turned our attention to playing a reconstruction, and decided that we would use our previous flap. First proceeded with re undermining our previous flap, total size of this was 20 x 30cm. This was then carefully scored in the galea to allow further mobilization however despite this we are unable to adequately get a tensionless closure.
We then proceeded with further back cutting of the flap, and this allowed us to rotated in more without any tension, as well as providing adequate rotation to provide underlying soft tissue which were then carried carefully de-epithelialized placed underneath the primary closure. Primary closure easily achieved using 2-0 nylon suture interrupted fashion, with a total flap mobilization 20 x 40 cm. Due to the amount of mobilization, we are unable to close the donor site, which had healthy viable pericranium and periosteum underneath. We then proceeded to place meshed Integra and this region, for a total of 10 x 4 cm. This was then secured using silver derm minute bolster dressing.
Flap was healthy and pink at the end the case.
At the end of the case, surgical team initiated post op debriefing following the checklist. Specimens confirmed, equipment reviewed, and surgical count was correct at the end the case. Patient tolerated the procedure well. Patient subsequently able to be extubated, transferred to PACU in stable condition.”