Reconstruction of Chronic Complicated Scalp and Dural Defects Using Acellular Human Dermis and Latissimus Dorsi Myocutaneous Free flap

Abstract

We present reconstruction of a complicated scalp-dura defect using acellular human dermis and latissimus dorsi myocutaneous free flap. A 62-year-old female had previously undergone decompressive craniectomy for intracranial hemorrhage. The cranial bone flap was cryopreserved and restored to the original location subsequently, but necessitated removal for a methicillin-resistant Staphylococcal infection. However, the infectious nidus remained in a dermal substitute that was left over the cerebrum. Upon re-exploration, this material was removed, and frank pus was observed in the deep space just over the arachnoid layer. This was carefully irrigated, and the dural defect was closed with acellular dermal matrix in a watertight manner. The remaining scalp defect was covered using a free latissimus dorsi flap with anastomosis between the thoracodorsal and deep temporal arteries. The wound healed well without complications, and the scalp remained intact without any evidence of cerebrospinal fluid leak or continued infection.

Load-deformation characteristics of acellular human scalp: assessing tissue grafts from a material testing perspective

“…Besides their orthotopic use, acellular skin grafts are frequently used as heterotopic grafts in various body sites 5 , 23 – 25 . In this study, we have shown that human AS is significantly more elastic compared to human ATMF and ADM.…”

The use of human acellular dermal matrices in advanced wound healing and surgical procedures: State of the art

“…Several retrospective case series suggest that hADMs are a reliable adjunct in the reconstruction of the neuro-and viscero-cranium, such as the correction of bone and dura madre full-thickness defects or the contour deformities of the scalp secondary to trauma. 12,35 Recently, a promising experience was also reported in the surgical treatment of the aplasia cutis congenital defect of the scalp dermo-hypodermic tissues. 36 and homologous skin grafts or paraffine gauze can be used as a coverage.…”

“…The hADMs sheets can be easily used in dura madre (ie, post‐craniotomy duraplasty) or skull base reconstruction: among the reported advantages, no cases of cerebrospinal or adherences formation and little or no morbidity in the endoscopic reconstruction of large anterior skull base defects (> 2 cm) using commercial hADM. Several retrospective case series suggest that hADMs are a reliable adjunct in the reconstruction of the neuro‐ and viscero‐cranium, such as the correction of bone and dura madre full‐thickness defects or the contour deformities of the scalp secondary to trauma 12,35 . Recently, a promising experience was also reported in the surgical treatment of the aplasia cutis congenital defect of the scalp dermo‐hypodermic tissues 36 …”

Research and application progress on dural substitutes

“…Therefore, dural substitutes made from allogeneic dura mater were gradually withdrawn from the historical stage when the source of the dura mater was insufficient and the transmission of prions could not be completely avoided [24,25]. Domestic and foreign scholars have also tried to use amniotic membrane, dermis, and other allogenic materials to prepare dural substitutes and have achieved some positive results [26][27][28]. However, owing to the lack of sources of allogenic materials, this type of material has not been widely used.…”