Reconstruction of Full Thickness Defects on the Scalp With Artificial Dermal Regeneration Template: Analysis of Long-Term Results in 68 Cases

Abstract

BACKGROUND Artificial skin substitute templates have been shown to be a reliable solution for the reconstruction of large scalp defects with exposed skull bone, but there is a lack of long-term data. OBJECTIVE The aim of this retrospective study was to investigate the long-term outcome of the procedure in a large cohort of 68 cases. MATERIALS AND METHODS In total, 58 patients with 68 full thickness scalp defects with exposed skull bone, were included. Mean follow-up time was 24 (±19) months. RESULTS The mean size of the defects was 63 (±54) cm2. During the follow-up period, no local recurrences occurred. Complications were observed in 13% of the cases including template necrosis (4%), infections (4%), ulcerations (3%), and autograft necrosis (2%). During the final follow-up, 26 patients had died due to internal diseases not associated with the surgery. Cosmetic results were rated good by the patients and an independent observer. CONCLUSION The use of a dermal regeneration template for the reconstruction of large, full thickness defects of the scalp with exposed skull bone is a reliable method regarding the complication rate, safety of the procedure, and cosmetic outcome. Limitations of this study are the retrospective and single center design.

Secondary Intention Healing Over Exposed Bone on the Scalp, Forehead, and Temple Following Mohs Micrographic Surgery

“…However, study design did not allow us to quantify any possible “stretch back,” or presumed reduction in healing time. Negative-pressure wound therapy, 14 artificial dermal regeneration template (Integra™), 15 partial decortication, 16 and innumerable alternative wound dressings have all been used to reduce time to complete healing. The study authors have limited experience with these therapies, but without control patients, their value over standard occlusive wound care cannot be ascertained.…”

Covering of large scalp defects prior to postoperative irradiation

“…Wound conditioning includes reaming the outer table, for example with a spherical bur, until punctate bleeding arises from the diploe, regular dressing changes and possibly vacuum-assisted wound therapy [15]. In addition, it is possible to cover scalp defects with absent periosteum by using dermis substitutes (for instance Integra TM bovine collagen matrix) [16,17].…”

Technical refinements in the use of dermal regeneration template in full thickness scalp defects after radical cancer surgery

“…The treatment by DRT is recommended in the following cases: 1) elderly or extreme elderly patients which may present additional risk factor related to comorbidity [9,17,18] 2) in case of wide local excision (>4cm) [19][20][21] 3) in case of bone exposure resulting from the removal of the periosteum [8,9,22]; in this case it is recommended to drill the outer table to vascularize the DRT from the bone marrow [23] 4) in case of previous surgery with graft or flap failure or in case of recurrence of the neoplasm [9,24,25] 5) in case of previous radiation therapy (pre or postoperative irradiation at the surgical site) [26][27][28] 6) in patients with very aggressive cancer in which close postoperative clinical surveillance is deemed necessary. [17,21,24,27,29,30] There is also agreement among the authors that the use of the DRT is more economically advantageous than the cover with flaps [31] especially if the operated surface is greater than 120 square cm [23]. Some authors have proposed the use of the DRT with the one step technique without subsequent thin skin grafting, thus favoring healing by secondary intention [32].…”