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Granulation tissue growth over exposed bone may be facilitated by creating fenestrations on the exposed bone. We report the case of a 6-year-old girl with a large-sized scalp laceration (10 cm × 6 cm) with bone exposure (4 cm × 3 cm) due to a road traffic accident in the Kingdom of Eswatini. We treated the wound with saline-soaked gauze dressing and drilled several holes on the exposed bone to enhance secondary healing. The aim of this case report was to provide a successful application of “Drill holes” procedure or trephination of exposed calvarium for the treatment of exposed bone and large-sized scalp lacerations in resource-poor areas, where flaps or more complicated procedures are not feasible.