The use of tissue expansion in the context of cranioplasty is relatively uncommon. The treatment of intractable increased cranial pressure (ICP) after traumatic brain injury (TBI) may result in decompressive craniectomy and requires reconstruction with a cranioplasty to avoid the long-term complications of large skull defects. These cases can be increasingly difficult if issues arise regarding wound closure or dehiscence, infection or implant exposure. The use of tissue expansion prior to cranioplasty can help to improve soft tissue coverage, reduces the tension across the cranioplasty wound closure and therefore reduces the risk of wound complications and implant infection.Here, we present an interesting case of tissue expansion used in the management of recurrent cranioplasty infections.