Skin reconstruction on exposed calvarium with Recell Therapy – Case report

Abstract

<b>Introduction:</b> The management of exposed calvarium in certain patients can pose as a challenge to surgeons. Several methods of management of such defects have been described. However, these methods may not be suitable for certain cohort of patients due to increased frailty and their complex medical co-morbidities. Recell® System (Avita Medical) is a device that allows clinicians to harvest skin cells from patients' own skin under local anaesthetic. <b>Methods:</b> A 63-year-old male who initially presented with multiple cutaneous squamous cell carcinoma on his scalp. His medical co-morbidities include idiopathic thrombocytopenic purpura and non-insulin dependent diabetes. He was unfit for the procedure under general anaesthetic. He had excision of the lesions and reconstruction with a split thickness skin graft under local anaesthesia. Subsequently, the skin graft failed and left multiple extensive areas of exposed calvarium despite having a week course of prophylactic antibiotics. Due to his susceptibility to infections, we opted to reconstruct the defect with Recell therapy only under local anaesthesia. <b>Results:</b> The patient had surgery which involved bone debridement and harvesting skin cells with Recell device from the split thickness skin graft harvested from the left upper arm under local anaesthesia. The cells were delivered via a spray-on system onto the defect and dressed. The dressings were changed weekly until complete wound healing. Complete skin epithelisation was observed at 5 months post-operatively. <b>Conclusions:</b> Recell® therapy should be considered as an armamentarium of managing exposed bone in patients with multiple medical co-morbidities.