Dermal Regeneration Template Research Articles

Indications and functional outcome of the use of integra® dermal regeneration template for the management of traumatic soft tissue defects on dorsal hand, fingers and thumb

Few studies have been conducted to explore the utility of the Integra® dermal regeneration template (IDRT) combined with a delayed split-thickness skin graft (STSG) for reconstructing complex dorsal hand, digit, and thumb injuries. This study reports the indications and outcomes for 14 patients treated with this technique via a two-stage process. We retrospectively reviewed all patients treated by IDRT combined with STSG from May 2015 to October 2018. The inclusion criterion was traumatic or post-infectious soft tissue defects (STDs) of the dorsal hand, fingers, and thumb, not suitable for direct wound closure and requiring local, pedicle, or free flap reconstruction. After debridement, a two-stage procedure was applied, namely IDRT followed by STSG. Indications, functional outcomes, aesthetic results, complications, patient satisfaction, and the STSG take rate were evaluated over a 36-month follow-up using standardised instruments. A total of 14 patients with 15 reconstructions (average age = 48years) were included. The dominant hand was involved in 50% of cases. Dorsal STDs involved the hand, fingers, thumb, and hand and thumb in 7, 3, 2 and 2 cases, respectively. The mean STD size was 35cm2 (range: 3-150cm2). The wound was associated with exposed tendons (without peritenon), bone (without periosteum), and joints (without a capsule) in eight cases (57%). The IDRT/STSG take rate was 97%. The average Vancouver Scar Scale score was 2 (1-4). The 36-month follow-up demonstrated that IDRT is a safe and reliable technique that can be considered a viable alternative to flap reconstruction for the management of traumatic STDs in selected patients. The aesthetic outcomes are acceptable, functional recovery of the fingers is excellent, patient satisfaction is very high and the rate of complications is very low.

Adipose Stem Cells and Platelet-Rich Plasma Induce Vascular-Like Structures in a Dermal Regeneration Template.

In the context of biointeractive dressings used for enhancing wound healing, the use of stromal vascular fraction (SVF) or adipose-derived stem cells (ASCs) hereof derived has not been fully exploited yet. Noncultured SVF, a heterogeneous mesenchymal population of cells, is attractive in the field of dermal regeneration because it can be instantaneously obtained, avoids genomic alterations, and is comparatively safer than cultured ASCs. Integra® Dermal Regeneration Template (DRT) was sprinkled with ASCs in complete medium supplemented with 10% fetal bovine serum (FBS), or SVF, obtained from emulsified or nonemulsified fat, in medium supplemented with 2% platelet-rich plasma (PRP). The presence and differentiation of cells were evaluated by standard histochemistry and immunohistochemistry, whereas conditioned media were analyzed for vascular endothelial growth factors (VEGF) by ELISA. In vitro experiments were conducted to analyze ASC proliferation in the presence of either FBS or PRP. Deposition of ASCs in medium supplemented with FBS caused their integration into Integra DRT as early as 1 h. ASCs were found as aggregates until 6-10 days without forming organized structures. When seeded onto Integra DRT, SVF cells in medium supplemented with PRP formed aggregates at early times, which at 7 and 10 days organized into vascular-like structures, lined by CD31+ and smooth muscle actin-positive cells. With nonemulsified fat, the lacunar structures did not show an organized distribution of SVF cells. PRP induced ASC proliferation although at lower level than FBS. VEGF secretion was enhanced when fat emulsification was introduced into the protocol. In conclusion, the combination of SVF cells obtained from emulsified fat, PRP, and Integra DRT exhibit synergistic effect on the formation of vessel-like structures indicating a step forward aimed at regenerative surgery for chronic wound healing.

Full-thickness Skin Microcolumns Implanted into a Dermal Regeneration Template: A Novel Method for “Donor-free” Skin Replacement Therapy

BACKGROUND: Split-thickness skin graft is the current standard in the treatment of large full-thickness skin defects. The donor site resulting from tangential skin harvest is well recognized as painful and unsightly, even after it has healed. Several efforts have been made in the past to address this problem by limiting the amount of skin harvested while significantly expanding the skin elements (ReCell, Meek). These efforts suffer from short comings such as graft fragility and failure to achieve adequate closure in a reasonable period of time. Full-thickness skin columns are a novel concept in skin harvest with little to no donor site when the diameter of the columns falls below a certain threshold. There is also a theoretical advantage that the columns harvested contain elements of full-thickness skin including sweat glands and hair follicles. Here, we present 2 cases where full-thickness skin columns were harvested and implanted into a bilayer dermal regenerative template (Integra) to achieve durable single-stage skin replacement. METHODS: Wounds in 2 elderly patients were treated using standard excisional preparation techniques. Both patients refused a standard split-thickness skin graft with concerns of difficulty healing the donor site. Informed consent using full-thickness skin columns and Integra combination were obtained. Full-thickness skin columns were harvested from a small area of the upper thigh using skin biopsy punches (1.5–2 mm). The columns were implanted orthotopically into a sheet of Integra dermal matrix with the epidermis placed immediately deep to the silicone layer. The Integra-skin column composites were applied onto the wounds similar to a traditional skin graft. The punch biopsy donor sites were allowed to heal secondarily. RESULTS: Patient 1 was 90 years old and had a small lower extremity wound treated with 2 mm skin columns (n = 9) and a 3 × 1.5 cm2 Integra. Patient 2 was 88 years old had a larger volar forearm wound treated with 1.5 mm skin columns (n = 51) and an 8 × 5 cm2 Integra. Visual evaluation showed centripetal healing with epithelial cells radiating from the columns as well as from the periphery. Complete healing was achieved in 3–4 weeks; donor sites healed in less than a week with minimal evidence of skin harvest at 1 month. CONCLUSIONS: Full-thickness skin columns implanted into a dermal regeneration template represent a novel technique for skin replacement that allows single-stage healing of full-thickness skin wounds with little to no donor site, and without any biochemical processing of the tissue.

Application of NATROX® topical oxygen therapy in neck wounds after radiotherapy

A 75-year-old Asian man presented with Notani Grade 3 osteoradionecrosis of the right mandible with an orocutaneous fistula. He underwent ablative resection with fibular free flap and pectoralis major myocutaneous flap reconstruction. Unfortunately, the neck wound dehisced with purulent discharge from the mandible. Initial management involved antibiotic therapy, debridement, and wound dressings. Further breakdown ensued, exposing the bone and mandibular reconstruction plate (Fig. 1). We debrided the wound, sectioned the exposed plate at the wound edges, and covered with an Integra® dermal regeneration template and a sponge bolster dressing, which was unsuccessful.

Surgical Reconstruction following Wide Local Excision of Malignant Melanoma of the Scalp.

Background:Scalp reconstruction in cases of melanoma excision can be challenging due to specific functional and aesthetic outcome requirements. Reconstructive techniques reported in the literature were reviewed to establish whether a surgical algorithm for the management of melanoma of the scalp may be deduced.Methods:A literature search was conducted to evaluate reconstructive strategies after melanoma wide local excision of the scalp according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Inclusion criteria were English language, diagnosis of melanoma of the scalp, and the presence of the following data: characteristics of the residual defect (width and depth), type of reconstruction, follow-up, and surgical outcome.Results:Six hundred twenty-five records were identified after excluding the duplicates; 48 full-text articles were assessed for eligibility, and 17 records were selected for inclusion. A total of 39 patients were included in the review. The majority of patients (n = 20) underwent skin grafting subsequent to dermal regeneration template positioning. Local flaps (n = 10), free flaps (n = 7), skin grafting alone (n = 1), and dermal regeneration template positioning alone (n = 1) were less frequent.Conclusions:Numerous reconstructive strategies for the scalp are described in the literature. Melanoma patients present a greater variability in terms of general health conditions and social needs that must be taken into account while choosing the most suitable procedure.

Use of Integra® dermal regeneration template and flowable matrix to reconstruct an oral cavity defect involving the nasal floor.

Use of Integra® dermal regeneration template and flowable matrix to reconstruct an oral cavity defect involving the nasal floor.

Reconstruction of penile skin loss using a combined therapy of negative pressure wound therapy, dermal regeneration template, and split-thickness skin graft application.

This study evaluates the use of acellular dermal matrix (ADM) in conjunction with negative pressure wound therapy (NPWT) and delayed split-thickness skin graft (STSG) application as an alternative to free tissue transfer for defect coverage of the penile shaft. Five patients with genital lymphedema and one with penile skin deficiency underwent penile shaft reconstruction with a two-stage surgical procedure. The first procedure aimed to the correction of skin defect and to neodermis regeneration through the use of an ADM (Integra®, Integra Lifesciences Corp., Plainsboro, NJ, USA) and NPWT. The second procedure 3 weeks later aimed to the covering of the skin defect with an unmeshed STSG. Both the Integra and skin graft showed completely taking at 7 days postop. No major complications occurred. At 6 months grafts gained sufficient elasticity to allow the sliding of the epidermis over the dermal layer, similarly the physiological penile shaft skin. Our results suggest that combined therapy might be an alternative to free tissue transfer for defect coverage of the penile shaft, leading to a good esthetic result, an optimal shaft coverage and providing adequate extensibility during erections. For best results we advise that in these cases urologists should collaborate with plastic surgeons.

Reconstruction of Full Thickness Defects on the Scalp With Artificial Dermal Regeneration Template: Analysis of Long-Term Results in 68 Cases

Artificial skin substitute templates have been shown to be a reliable solution for the reconstruction of large scalp defects with exposed skull bone, but there is a lack of long-term data. The aim of this retrospective study was to investigate the long-term outcome of the procedure in a large cohort of 68 cases. In total, 58 patients with 68 full thickness scalp defects with exposed skull bone, were included. Mean follow-up time was 24 (±19) months. The mean size of the defects was 63 (±54) cm2. During the follow-up period, no local recurrences occurred. Complications were observed in 13% of the cases including template necrosis (4%), infections (4%), ulcerations (3%), and autograft necrosis (2%). During the final follow-up, 26 patients had died due to internal diseases not associated with the surgery. Cosmetic results were rated good by the patients and an independent observer. The use of a dermal regeneration template for the reconstruction of large, full thickness defects of the scalp with exposed skull bone is a reliable method regarding the complication rate, safety of the procedure, and cosmetic outcome. Limitations of this study are the retrospective and single center design.

Integra® dermal regeneration template for full thickness carcinologic scalp defects: Our 6 years’ experience retrospective cohort and literature review

BackgroundThe aim of the study is the use of Integra® dermal regeneration template (DRT) in scalp reconstruction after tumor resection by comparing results of literature and Gustave Roussy Institut’ series of 20 patients. Materiel and methodsA systematic review, with a PubMed search was performed using the following key words “artificial dermis OR DRT” AND “scalp”. Eligible articles were selected to study patients and defects characteristics, operative modalities, and the follow up results. This case series presents the experience of immediate DRT reconstruction after scalp full thickness carcinologic surgery, in the plastic surgery service of Gustave Roussy cancer center. ResultsTwenty patients with primary scalp tumors underwent two steps DRT reconstruction for full thickness scalp defect. The mean surface defect was 72cm2. The mean operative combined time was 94min, with a total healing delay of 68 days. All patients successfully recovered. Five patients had minor complications (3 delayed healing and 2 DRT infections) with no need of additional surgery. Fourteen articles, totalizing n=210 patients, were included and reviewed. Reported ages ranged from 58 to 82 years old. Almost all patients were operated for oncologic resections. The mean surface defect was 73cm2. The mean follow-up was 15 months. The skin graft taking rates ranged from 95% up to 100%. ConclusionIn large scalp full thickness defects after cancer resection, DRT appears to be a suitable reconstruction option for patients with comorbidities, and aggressive tumors. This technique allows immediate coverage of the calvarium with short operative time and prevents from healing delay. The oncologic follow-up is no disturbed and cancer recurrences are easily diagnosed.

Infectious Complications Associated with the Use of Integra: A Systematic Review of the Literature.

Background:Dermal regeneration templates such as Integra are effective reconstructive biomaterials used in a variety of soft-tissue defects. Fully understanding the complications associated with their use is paramount to improve outcomes and maximize patient safety. In this study, our purpose is to perform a comprehensive literature review to assess the previously reported infectious complications linked to Integra-based wound closure.Methods:We conducted a systematic review of the literature to identify previous articles indexed in PubMed and Ovid for Integra and its synonymous terms. We used these search terms: [Integra OR (dermal regenerative matrix) OR (dermal regeneration matrix) OR (dermal regenerative template) OR (dermal regeneration template) OR (dermal substitute) OR (skin substitute) OR (artificial skin)] AND infection.Results:Of the 3508 articles for initial review, 69 reported rates of infection, of which 26 reported ≥1 infection within their cohort. Of these 26 articles, the patients (n = 602) underwent Integra-based reconstruction in 1254 sites and had reported infections in 212 of the sites (16.9%). Among these, we encountered a single report of a fatal case of toxic shock syndrome (TSS) related to the use of Integra in secondary burn reconstruction.Conclusions:While Integra offers many benefits, surgeons must be aware that infectious complications are not uncommon. As a result, a careful risk–benefit analysis of its use in reconstruction must be performed, and open discussion with the patient preoperatively regarding infection rate is of utmost importance.

Three-year experience with Integra dermal regenerative template as a reconstructive tool

Background Since the introduction of Integra dermal regeneration template, several reports have been published worldwide proving its ability as a less invasive reconstructive tool. Our aim is to report our 3-year experience with Integra as the first report from Kuwait. Patients and methods Integra was used for reconstruction of a wide variety of complex wounds in different body locations. The dermal regenerative template replaced soft tissue defect as a first stage followed by skin grafting as a second stage. Forty patients were included with mean age of 40.2±20.7 years, with 24 cases having one or more comorbidities. Twenty-five patients were female and 15 were males. We had 20 cases with exposed underlying structures in wound bed, including bones, tendons, and joints. Results The average engraftment rate of Integra was 97±10.2%. Average time for skin grafting was 20.4±4.8 days and average skin graft take was 95±10.9%. Early complications included a case of Integra infection and another case of hematoma. After skin grafting, there were two cases of partial graft losses that healed without the need for regrafting. Complete wound healing was achieved in all cases within 8 weeks. Mean follow-up period was 16.65±8.4 months. No contracture or recurrent ulceration was documented. Apart from hyperpigmentation, 95% of the patients were satisfied with reconstruction outcome, with normal skin pliability in 95% cases, and normal range of movement in 85% of cases. Conclusion Integra is efficient and safe, with wide range of clinical indications. It has very high engraftment rate even in complex wounds with exposed bone or tendon. We observed high patient satisfaction and excellent pliability and final function.

Outcomes and Predictors of Wound Healing among Patients with Complex Diabetic Foot Wounds Treated with a Dermal Regeneration Template (Integra).

The utility of dermal regeneration templates for treating high-risk diabetic foot wounds is unclear. The authors report wound healing and major amputation outcomes among a cohort of diabetic patients with complex diabetic foot wounds treated in a multidisciplinary setting. All patients with complex diabetic foot wounds treated with a dermal regeneration template (March of 2013 to February of 2019) were captured in a prospective institutional database. Wound severity was classified according to the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system to determine limb salvage prognosis at baseline. Wound healing and major amputation rates were reported using Kaplan-Meier analyses. A stepwise Cox proportional hazards model was used to identify independent characteristics associated with wound healing. Eighty-five patients with 107 complex diabetic foot wounds were treated (mean age, 61.2 ± 3.3 years; 63.5 percent male and 61.2 percent African American). Most diabetic foot wounds were high-risk (wound, ischemia, and foot infection stage 3 or 4, 93.5 percent), corresponding to a predicted 25 to 50 percent risk of major amputation at 1 year. Dermal regeneration template use resulted in successful wound granulation in 66.7 percent of cases, with a mean time to complete wound healing of 198 ± 18 days. Twelve- and 18-month wound healing rates were 79.0 ± 5.0 percent and 93.0 ± 3.3 percent, respectively. Major amputation was required in 11.2 percent of patients. Independent predictors of poor wound healing included lack of bone involvement, higher WIfI stage, and prior dermal regeneration template failure. Application of a dermal regeneration template to complex diabetic foot wounds at high risk for major amputation results in good wound healing and excellent limb salvage outcomes among diabetic patients treated in a multidisciplinary setting. Therapeutic, IV.

Reconstruction of Full Thickness Scalp Defects in Extremely Elderly Patients Using Dermal Regeneration Templates.

The reconstruction of full thickness scalp defects following oncologic resection poses a unique challenge that is further magnified in "extremely elderly" patients, defined as those in at least their ninth decade of life, who are often unsuitable candidates for complex reconstruction. A "simpler" option is two-stage reconstruction: placement of Integra dermal regenerative template (Integra Life Science, Plainsboro, NJ) followed by a split thickness skin graft (STSG). This case series illustrates the success of this technique in the extremely elderly. A retrospective analysis of patients > 80 years at the time of surgery who underwent full thickness scalp reconstruction following tumor extirpation in a two-stage approach under the care of single surgeon from January 2010 to June 2019 was conducted. Variables reviewed were medical history, surgical treatment response, time to split thickness skin graft, follow up, and success of wound coverage. Fourteen patients, with a mean age of 87 years (range: 80 to 101, median: 87), met inclusion criteria. Split thickness skin grafts were placed after an average of 18 days. Twelve patients had successful two-stage reconstruction with 100% take. One patient developed a hematoma under a portion of the template that neither required reoperation nor delayed split thickness skin graft placement. A second suffered from insufficient vascularization of the template with delay to split thickness skin graft and incomplete wound closure. This two-stage approach is a successful primary reconstructive option for definitive management of full thickness scalp defects following oncologic resection in extremely elderly patients.

The use of Integra® for abdominal reconstruction after a necrotizing fasciitis in a child

Abstract Necrotizing fasciitis is a rare infection, often requiring large debridement's due to its rapid spread in the soft tissues. Reconstruction is always a challenge. We report the successful use of Integra® Dermal Regeneration Template, combined with Negative Pressure Wound Therapy and thin skin grafts, and a local flap, to reconstruct the abdominal skin in a 7-year-old boy who developed a necrotizing fasciitis after a trauma with his scooter. Stable coverage was achieved, without skin retraction and with a preserved range of motion at 1-year post-operatively.

The Use of Collagen-Glycosaminoglycan Biodegradable Matrix (Integra®) in the Management of Neck Postburn Hypertrophic Scars and Contractures

Glycosaminoglycan (GAG) is a chain-like disaccharide that is linked to a polypeptide core to connect two collagen fibrils/fibers and provide the intermolecular force in a Collagen-GAG matrix which can be a valuable treatment of post-burn contractures and hypertrophic scars, which remain a challenge to reconstructive surgery. The face and neck contractures are the most difficult sites to treat. This article is meant to discuss our clinical experience in using collagen-glycosaminoglycan biodegradable matrix (Integra® Integra Lifesciences Corporation, Plainsboro, NJ, USA) to reconstruct defects created by excision of contracted areas from the neck and lower face areas. Between 2009 and 2011, we had 11 patients that underwent Integra reconstructive procedures. The mean follow-up period was 18 months. For all the patients, the intake of the Integra dermal regeneration template was 100%, even if one patient developed a minor infection treated with appropriate antibiotics. The patients are very satisfied with the result. A minor problem was a small difference in skin color, but this inconvenience was compensated by good skin elasticity.

Restoring full-thickness skin defects with a dermal regeneration template and dermal-epidermal cell suspension in a patient with junctional epidermolysis bullosa.

Restoring full-thickness skin defects with a dermal regeneration template and dermal-epidermal cell suspension in a patient with junctional epidermolysis bullosa.

851 Hidradenitis Suppurativa: Our Institutional Experience over the Last 6 Months with Improved Definitive Management and Quality of Life

Abstract Introduction Hidradenitis suppurativa (HS) has prevalence of 0.05–4.1% and is more common in women, with an onset typically occurring after puberty. HS is often under-recognized, mismanaged, and is associated with comorbidities and decreased quality of life. Currently, management is tailored to the phase of the disease; medically treating the inflammatory phase and surgically managing the fibrotic phase. The tissue-sparing surgery can be disfiguring and may not protect against recurrence. The aim of this case series is to highlight a novel therapy as a treatment option for chronic, recalcitrant HS. Methods Four HS patients underwent a novel treatment in the burn unit at our institution. Patients underwent excision of wounds, dermal regenerative template (DRT) placement, and were dressed with a silver-impregnated negative pressure therapy wound vac. On hospital day 5 the wound vac was changed and on day 10 the patient returned to the operating room for removal of the silastic layer of the DRT with formal split thickness skin grafting (STSG) over the neodermis and replacement of the silver-impregnated negative pressure therapy wound vac. On hospital day 15, the VAC was taken down, the graft site was transitioned to daily xeroform and bacitracin dressing, and the patients were discharged home. Results Four patients with ages ranging from 27–60 years with an average disease duration of six-years underwent the novel treatment at our institution. Two patients had HS more prominent on the buttock with the other two patients presenting with axilla involvement. One patient had limited range of motion to the shoulders secondary to chronic contractures. All patients had failed multiple local incision and drainage procedures as well as complex medical therapies including but not limited to chronic antibiotic suppression and immunotherapies. Each patient underwent two operative procedures with three patients requiring one additional bedside wound vac change. All patients were discharged home within fifteen days from the initial procedure with acceptable wound coverage. Conclusions Four patients with HS underwent a novel therapy; tolerated the procedures well, had excellent adherence, and were satisfied with the results. This provides evidence for the validity of this therapy utilizing the above described staged operative approach resulting in definitive management and acceptable cosmetic results. Applicability of Research to Practice By utilizing this novel approach and the multidisciplinary burn team, patients who suffer from long-standing HS may have improved quality of life.

Use of Integra Dermal Regeneration Template for Limb Salvage in Diabetic Patients With No-Option Critical Limb Ischemia.

We have analyzed in a retrospective study of consecutive diabetic patients affected by no-option critical limb ischemia (CLI) the efficacy of the dermal substitute Integra Dermal Regeneration Template for treatment of complicated foot lesions. The primary end point was limb salvage and 1-year amputation-free survival. The secondary end point was healing time of surgical site. Between October 2014 and October 2017, 1024 patients with diabetic foot ulcer (DFU) and CLI were admitted. In 84 patients (8.2%), there was a failure in distal revascularization with a persistent CLI after the procedure. Despite the persistent CLI, a group of 26 patients of this cohort obtained complete wound healing. Among them, 13 patients were treated with surgical debridement or open amputations and application of dermal substitute Integra Dermal Regeneration Template and the other 13 patients were treated without any dermal substitute. The Integra group healed within a mean time of 83.5 days, and the control group healed within a mean of 139 days (P = .028). No major amputation was carried out at 1-year follow-up in the Integra group versus 15% in the control group. A conservative foot surgery or an approach with minor amputation in diabetic patients with no-option CLI may achieve limb salvage. The use of Integra Dermal Regeneration Template in patients with DFU and no-option CLI may be a useful option in a limb salvage program.

The Role of Adipose-Derived Stem Cells, Dermal Regenerative Templates, and Platelet-Rich Plasma in Tissue Engineering-Based Treatments of Chronic Skin Wounds.

The continuous improvements in the field of both regenerative medicine and tissue engineering have allowed the design of new and more efficacious strategies for the treatment of chronic or hard-to-heal skin wounds, which represent heavy burden, from a medical and economic point of view. These novel approaches are based on the usage of three key methodologies: stem cells, growth factors, and biomimetic scaffolds. These days, the adipose tissue can be considered the main source of multipotent mesenchymal stem cells, especially adipose-derived stem cells (ASCs). ASCs are easily accessible from various fat depots and show an intrinsic plasticity in giving rise to cell types involved in wound healing and angiogenesis. ASCs can be found in fat grafts, historically used in the treatment of chronic wounds, and have been evaluated as such in both animal models and human trials, to exploit their capability of accelerating wound closure and inducing a correct remodeling of the newly formed fibrovascular tissue. Since survival and fitness of ASCs need to be improved, they are now employed in conjunction with advanced wound dressings, together with dermal regenerative templates and platelet-rich plasma (as a source of growth and healing factors). In this work, we provide an overview of the current knowledge on the topic, based on existing studies and on our own experience.

Morbidity in Patients With Separation of Cartilaginous Framework: Temporoparietal Fascia Flap and Treatment With Dermal Regeneration Template.

The full creation of an ear requires 2 reconstruction stages. In the second stage of reconstruction, the cartilaginous framework placed at first stage is separated from the head creating an auriculocephalic sulcus. Then a piece of rib cartilage is placed in the sulcus to maintain this separation and is covered with tissue that allows the integration of a full-thickness skin graft. A descriptive study based on the pre and postoperative medical records and photographic archives of patients diagnosed with microtia who underwent separation of the cartilaginous framework from February 2010 to July 2015 in the Plastic and Reconstructive Surgery Department at Hospital General Dr. Manuel Gea González. Fifty-four patients met the selection criteria. The temporoparietal fascial flap was performed on 85% (n = 46), and 8 cases with random occipito-temporal fascial flap in association to a dermal regeneration template. The average time at the operating room was 177 minutes in patients with temporoparietal fascial flap versus 84.5 minutes in dermal regeneration template. The complication rate was 25.9% (n = 14), being similar rate with both techniques. Coverage with dermal regeneration template and random occipito-temporal fascia flap as an alternative use instead of temporoparietal fascial flaps, offers good postoperative results, lower operating times, and similar rate of complications, with the advantage of producing no visible scars and reserve the temporoparietal fascial flap for possible exposure of the cartilaginous framework.