Can a Single-Stage Approach Using a Dermal Regeneration Template Lead to Satisfactory Scalp Defect Reconstruction After Skin Cancer Excision?

Abstract

Large-defect reconstructive surgeries for skin cancer can be performed using different approaches. Integra Dermal Regeneration Template (DRT, Integra Life Sciences, Princeton, New Jersey, the United States) is a membrane utilized to fill skin defects, followed by second-stage surgery with a full-thickness skin graft or flap. To evaluate the frequency of success of the single-stage scalp reconstructive surgeries using the DRT membrane without second-stage surgery and its feasibility in practice. This retrospective case series study was conducted to investigate the outcomes of patients with skin cancer scalp defects, reconstructed using DRT, from June 2019 to June 2022, in the Oral and Maxillofacial Department at Ashford and St. Peter's Hospitals, United Kingdom. The patients who underwent further surgery were excluded. Not applicable. This study aimed to evaluate the achievement of complete re-epithelialization solely using the DRT membrane along with appropriate dressing management, scored as a "yes" or "no." Patient's age, defect size, timing of bolster, DRT silicone layer, and dressing removal; anticoagulation, antibiotics, complications, and appointments until complete healing. Descriptive statistics were computed for each variable. Forty patients were included in this study and 90% re-epithelialized without complications. Two cases of infection and three bleeding events were recorded. The mean patients' age was 81.5±7.7years, and the average defect size was 14.7±10cm2. The bolster and silicone layers were removed at 9.1±3.2 and 29.2±12.9days, respectively. The average number of appointments until healing was 7.8±4.8. Healing time was 3.8±2.1months, frequency of failure was 10, and 40% received antibiotics. In our experience, the DRT membrane can be used as a successful single-stage approach in minimizing the need for further surgery. Further studies are needed.