Reconstructive surgery of the skull following decompressive craniotomy or removal of a bone flap often develops postoperative skull infections. We report a case of reconstruction of skull and scalp defects using split rib cranioplasty and a latissimus dorsi myocutaneous flap after a hydroxyapatite artificial bone graft became infected. A 49-year-old man with a ruptured aneurysm of the left middle cerebral artery underwent neck clipping and external decompression. At the first postoperation month, cranioplasty was performed using a hydroxyapatite graft. Thirteen months later, an abscess around the implanted hydroxyapatite developed and was removed. Two months after the third surgery, the patient underwent reconstruction of his skull and scalp defects using split rib cranioplasty and a latissimus dorsi myocutaneous flap. Thereafter, he did not experience any infectious episodes of the skull and scalp.