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Intracranial injury has been reported secondary to not only blunt and penetrating trauma but also thermal and high-voltage electrical injury. Reconstruction can be challenging, especially in the face of necrosis of large areas of the cranium. The authors present a novel case of fourth-degree thermal burn to the head caused by a rotating tire. Initial wound debridement exposed dura, prompting a dural patch and Integra® for temporary coverage. Definitive coverage was accomplished with a latissimus dorsi free flap. The injury was complicated by associated neurologic defects and seizure activity. However, management was effective, and at 1 year, the patient is alive and well.