Reconstruction of Complex Full-Thickness Scalp Defects After Dog-Bite Injuries Using Dermal Regeneration Template (Integra): Case Report and Literature Review

Abstract

The purpose of this article is to review the current applications of dermal regeneration templates in reconstruction of full-thickness scalp defects, most commonly resulting from oncologic surgery, and show its success in reconstruction of a complex full-thickness scalp defect resulting from a dog-bite injury. A systematic review conforming to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines was completed. A PubMed search was completed using key terms including Integra, dermal regeneration template, full-thickness scalp defects, dog-bite injuries, and scalp. Eligible articles were selected based on the characteristics of defect size, procedural protocol, and reconstruction modality. Outcomes reported were based on reports of follow-up, complications, and percentage graft take. The case report presents reconstruction of a complex full-thickness scalp defect due to a dog-bite injury with a dermal regeneration template. Fifteen articles were included. Reported ages ranged from 2 to 93years. The mean defect size ranged from 6 to 610cm2, with 67% of defects averaging more than 50cm2. All articles reported the 2-stage approach to Integra (Integra LifeSciences, Plainsboro, NJ)-based reconstruction with follow-up ranging from 5 to 23months, with only 2 articles reporting less than 90% graft take. Acellular dermal matrix provides an alternative reconstructive mechanism to free tissue transfer and flap reconstruction and offers a unique advantage in the medically complex patient, as well as in pediatric and geriatric populations. Successful Integra-based reconstruction of full-thickness complex scalp defects is well reported in the literature in relation to reconstruction of Mohs surgical defects, as well as burns of the trunk and extremities; however, reports of reconstruction of post-traumatic soft tissue defects of the head and neck are limited. On the basis of the reported successes from the reviewed literature, as well as the clinical outcome of the reported case, we believe Integra to be a valuable reconstructive tool in the algorithm for repair of post-traumatic, full-thickness, complex scalp defects when used appropriately.