Scalp Reconstruction Using Integra, an Alternative to Free Tissue Transfer—Case Report

Fung, Victoria; Chalmers, Richard; Geh, Jenny

doi:10.4236/oalib.1100747

Cited by 3 publications

(6 citation statements)

References 5 publications

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“…Five studies reported time to second stage >30 days. 12,14,20,24,36,37 All five reported a complication accounting for the delay.…”

Section: Resultsmentioning

confidence: 99%

“…The remaining 22 articles using unfenestrated Integra reported percent take ranging from 50% to 100%. 9–11,14–16,18–20,22–25,27,31–35,37,39,42 Fung et al 37 reported hematoma formation under unfenestrated Integra resulting in 90% graft take.…”

Section: Resultsmentioning

confidence: 99%

“…Studies utilizing unfenestrated Integra reported percent take ranging from 50% to 100%. Fung et al 37 did not fenestrate Integra before application and reported hematoma formation resulting in 10% graft failure. Although fenestration of skin grafts can result in unsatisfactory cosmetic results, Integra’s staged approach permits fenestration without substantial impact on final site appearance.…”

Section: Discussionmentioning

confidence: 99%

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Integra-based Reconstruction of Large Scalp Wounds: A Case Report and Systematic Review of the Literature

Johnson

Wong

2016

Plastic and Reconstructive Surgery - Global Open

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Background:Large complex scalp wounds that have traditionally required free vascularized tissue transfer have been successfully reconstructed with skin substitutes such as Integra. Although there are multiple reports of Integra-based reconstructions of scalp wounds, there has not been a comprehensive assessment of this body of literature that critically examines this method. Our goal was to conduct a systematic review to determine the effectiveness of Integra-based reconstructions of scalp wounds, with emphasis on large defects.Methods:A comprehensive systematic review was completed using key search terms, including Integra, dermal regeneration template, bovine collagen, skin substitute, forehead, and scalp. Selected articles reported characteristics of patients and their reconstructions. The primary outcome measures were wound complications and percent graft take.Results:Thirty-four articles were included in this systematic review. Wound sizes ranged from 5.7 to 610 cm2, with 35.3% of articles reporting a mean defect size >100 cm2. Thirty-two articles reported mean percent take of skin graft ≥90%. Sixteen articles reported a minor complication. There were no major complications associated with the reconstructions.Conclusions:There is a substantial evidence base for the use of Integra to reconstruct scalp wounds. To date, the dermal regeneration template is generally reserved for salvage procedures or when the patient cannot tolerate free tissue transfer. Based on the findings of this systematic review and the authors’ clinical experience, Integra can be used to achieve predictable results in large complex scalp defects.

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“…Five studies reported time to second stage >30 days. 12,14,20,24,36,37 All five reported a complication accounting for the delay.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Integra-based Reconstruction of Large Scalp Wounds: A Case Report and Systematic Review of the Literature

Johnson

Wong

2016

Plastic and Reconstructive Surgery - Global Open

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“…The 2stage use of Integra, followed by SSG was successful, and after 14 months the patient was fully healed with no recurrence. 22 Similarly, Cunningham et al obtained successful results with Integra followed by negative pressure wound therapy (NPWT) in a 63year-old man with numerous superficial and invasive SCC of the scalp that required excision of a total area of 400 cm 2 . 23…”

Section: Complex Wounds and Bone Exposurementioning

confidence: 98%

“…In terms of dressing the most commonly used options were bolstered dressing, 15,17,19,22,24,26,32,33 silver-impregnated dressing 6,16,25 and NPWT, 12,23,28,34,35 which is effective in reducing shearing forces across the surface of the dermal matrix by acting as a splint and forces the material on to the wound bed. The authors recommendation is to perform the dressing with nonadherent wound contact layer (eg, fatty gauze) on top and apply Betadine gel (Braunol; B. Braun, Milan, Italy), silver sulfadiazine or other silver dressings to the edge, followed by traditional compressive over the bandage.…”

Section: Tumor Characteristicsmentioning

confidence: 99%

Integra in Scalp Reconstruction After Tumor Excision: Recommendations From a Multidisciplinary Advisory Board

Magnoni

Santis²,

Fraccalvieri

et al. 2019

Journal of Craniofacial Surgery

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Integra is a dermal regeneration template used in the reconstruction of burns, traumatic injuries, or excision lesions in patients who present particular risk factors for traditional surgical procedures. A multidisciplinary advisory board of expert dermatologists and plastic surgeons have discussed the use of Integra in the reconstruction of scalp defects after tumor excision, focusing on the evidence derived from literature and on their experience in the treatment of approximately 400 patients. In this position paper, the authors summarize the main evidence discussed during the board, and the common practice guidelines proposed by the experts. The use of Integra is recommended in elderly patients with multiple comorbidities who have a higher risk for potential complications in traditional surgery; these patients may in fact benefit from a lower anesthetic risk, a less complicated postsurgical care and limited morbidity at the donor site obtained with the dermal template. Integra should also be used in the reconstruction of large and complex wounds and in case of bone exposure, as it helps to overcome the challenges related to wound healing in difficult areas. Notably, Integra has proven to be effective in patients who have undergone previous surgical procedures or adjuvant radiation therapy, in which previous incisions, scarring and radiation damages may hamper the effectiveness of traditional procedures. Finally, Integra is recommended in patients with recurrent and aggressive tumors who need closer tumor surveillance, as it gives easy access to the tumor site for oncologic follow-up examination.

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

M¹,

Castronovo²,

Teglas³

et al. 2021

Glob Surg

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Background:The incidence of scalp neoplasms is continuously increasing as a consequence of the progressive aging of the population. The need to perform a correct excision of scalp neoplasms often requires the removal of the entire skin, galeal and periosteum lining. The consequent complete uncovering of the thecal bone does not allow any type of local grafting and, in the past, has always involved the need to carry out the recovering using local or free flaps. The preparation of the local flaps generally involves large detachments of the scalp, which can cause severe complications of the haemorrhagic type, especially in elderly patients with anticoagulant or antiplatelet treatments. The realization of free flaps, on the other hand, involves a greater anesthetic effort and the creation of a further sacrifice in the donor site. Methods:The introduction of Dermal Regeneration Templates made it possible to undertake repairing techniques for full-thickness lesions of the scalp with the simple aid of local anesthesia without the need to suspend antiplatelet treatments. The interventions based on the use of Dermal Regeneration Templates are not complex, however they require particular and simple measures which, if not applied, lead to not entirely satisfactory results. This work describes a method of using Dermal Regeneration Templates in the repair of full-thickness lesions of the scalp that follows a rigorous protocol as result of constant internal review.In particular, we identified three details leading to better results:• continuous Ford interlocking suture with "double pass" in the DRT;• tie-over compression fixed by sutures anchored approximately 5-8 mm externally to the margins of the main suture (8 points);• antibacterial ointment sealing. Conclusions:In our opinion, a correct protocol concerning surgical techniques and dressing management allows the shortening of Dermal Regeneration Templates placing times from 6 to 4 weeks; better results in terms of percentage of area with good flourishness, less fluid collection under the Dermal Regeneration Templates and consequently the formation of a more homogeneous and better quality neoderm.

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Scalp Reconstruction Using Integra, an Alternative to Free Tissue Transfer—Case Report

Cited by 3 publications

References 5 publications

Integra-based Reconstruction of Large Scalp Wounds: A Case Report and Systematic Review of the Literature

Integra-based Reconstruction of Large Scalp Wounds: A Case Report and Systematic Review of the Literature

Integra in Scalp Reconstruction After Tumor Excision: Recommendations From a Multidisciplinary Advisory Board

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

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