Simple Approach to the Radiated Scalp Wound Using INTEGRA Skin Substitute

Abstract

The chronic irradiated scalp wound remains one of the most difficult reconstructions for the plastic surgeon. With its inherent radiodermatitis and poor healing potential, chronic ulcers down to bone will result if coverage cannot be achieved. Reconstructive procedures as simple as a skin graft have a high complication rate in the irradiated wound and often fail. Local tissue transfer also has a high failure and complication rate because of the decreased vascularity of the wound bed and radiation damage to the surrounding scalp tissue, limiting its manipulation. The authors report two cases using a simple method with INTEGRA bilaminate skin substitute (Integra Life Sciences, Plainsboro, NJ) for repair of difficult wounds of the radiated scalp. Case one involves a patient with nonhealing radiation ulcers that had failed local wound care, hyperbaric oxygen, and split-thickness skin grafting. Case two involves a patient with extensive squamous cell cancer of the scalp that recurred despite total scalp radiation, requiring resection of more than 50% of the total surface area of the scalp. Both these patients were successfully treated using INTEGRA artificial skin substitute (Integra Life Sciences). This simple method using INTEGRA (Integra Life Sciences) resulted in complete healing of the radiated scalp wound and an acceptable, functional, and cosmetic outcome with minimal morbidity to the patients.

Template for Skin Regeneration

“…48 Typically, the outer table is taken down with a burn until the diploic space is entered. 49 Dermal regeneration template is applied over the bone and attached to the surrounding normal skin.…”

Long-Term Superiority of Composite Versus Muscle-Only Free Flaps for Skull Coverage

“…Rather than using a muscle-only free flap if found to be thin, instead consideration for conversion to a musculocutaneous or even some other composite flap must then become the original plan. Whether these admonitions will be moot with the advent of Integra as a replacement for flaps is unknown, 14 as again, the long-term sequela with this skin substitute is not yet known.…”

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

“…Its use in managing burns has been well described [5]. However there is little literature on its use for reconstruction following oncological resections [1] [2].…”

“…Surgical excision is the preferred treatment, but can pose reconstructive problems. Resection to bone and adjuvant radiation are often required to minimize risk of recurrence [1] [2].…”