Reconstruction Of Full-thickness Scalp Defects Research Articles

The role of Integra in the reconstruction of full-thickness scalp defects

The role of Integra in the reconstruction of full-thickness scalp defects

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

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.

Total scalp reconstruction following a dog bite in a pediatric patient.

The purpose of this case report is to present the reconstruction of a full-thickness scalp defect in a 2-year-old Hispanic male mauled by a dog, which was performed by a novel technique. After the scalp defect was debrided multiple times and treated with greater than 600 cm2 of cryopreserved human skin allograft, Integra was applied to the scalp defect following debridement and burring-out the outer bony cortex to promote bleeding and integration, followed by the application of a VAC dressing. Four weeks later, the mature Integra was grafted with split-thickness grafts. One year after the original injury, the patient demonstrated 98% take of the skin grafts to the calvarium. The resultant soft-tissue cover was supple, pliable, uniform in texture, and stable. The proposed technique of reconstruction of large full-thickness scalp defects in pediatric patients is easily reproducible, involves a short operative time, and produces satisfying cosmetic results.

Use of Dermal Regeneration Template (Integra) for Reconstruction of Full-Thickness Complex Oncologic Scalp Defects

The reconstruction of full-thickness scalp defects remains a surgical challenge. Different types of reconstruction had varying success including the use of dermal regeneration template (DRT). We reviewed the surgical outcome of 30 patients who underwent application of DRT for resurfacing of full-thickness scalp defects when the pericranium was excised and the outer cortex of the calvarial bone was burred after the excision of scalp neoplasm. This was a retrospective review of 30 patients who had scalp reconstruction with DRT undertaken by the senior author between October 2004 and June 2007. The mean age of patients in our series was 63 years (37-91 years). There were 14 men and 16 women. The indications for re-excision and DRT reconstruction in 28 patients were close margins and aggressive tumor type, whereas 2 patients had a recurrence. The mean defect size was 95 cm2 (16-275 cm2). The second stage of the reconstruction occurred on postoperative day 42 (postoperative days 27-62). The mean follow-up period was 14 months. Two patients had minor complications. For both stages, the combined average operative time was 128 minutes. The use of DRT is a rung of the reconstructive ladder that deserves consideration. In our series of 30 patients who required secondary reconstruction of complex scalp defects, the use of DRT has been seen to provide safe and durable soft-tissue cover for full-thickness scalp defects. The reduced operative time and inpatient stay are desirable characteristics particularly in elderly patients with multiple comorbidities.

Occipital artery Island V–Y advancement flap for reconstruction of posterior scalp defects

The management of the posterior scalp defects with 'similar' tissue can be challenging. Currently available techniques of transposition/rotation result in creation of unwanted dog ears, change in direction of hairs and patches of skin-grafted areas with alopecia. We describe a new method of reconstruction of full-thickness scalp defects in the occipital region by moving the locally available scalp tissue in a V-Y advancement manner. The islanded flap is based upon the ipsilateral occipital artery in the substance of occipitalis muscle. The donor site/s can be closed primarily and the operation performed in a single stage A total of seven patients have undergone reconstruction in the last 2 years with this technique. The defects in the posterior scalp region resulted either from the electrical burns (two patients), tumour excision (two patients), encephalocoele excision (one patient) or post-traumatic loss of the scalp (two patients). In all the patients the underlying bone was exposed. The remaining scalp tissue in the vicinity of the defect was moved as a V-Y advancement flap either unilaterally or bilaterally depending upon the size of the defect. The pedicle of the flaps contained ipsilateral occipital vessels at the base. The flaps were raised in the subgaleal plane and the pedicle included ipsilateral occipital artery in the substance of the occipitalis muscle. The donor area could be closed primarily in all cases. All the flaps survived completely; one patient had postoperative superficial loss that eventually healed with dressings. All the wounds healed primarily with luxuriant hair growth, except one patient who had partial alopecia in the transferred flap although the flap survived completely. The islanded occipital artery V-Y advancement flap provides a one-stage hair-bearing scalp tissue for closure of medium and moderately large defects (up to 7 x 6.5 cm(2)) in the posterior region of the scalp with primary closure of the donor site.

Removal of the Outer Table of the Skull for Reconstruction of Full-Thickness Scalp Defects with a Dermal Regeneration Template

Removal of the Outer Table of the Skull for Reconstruction of Full-Thickness Scalp Defects with a Dermal Regeneration Template

Removal of the Outer Table of the Skull for Reconstruction of Full-Thickness Scalp Defects with a Dermal Regeneration Template

The reconstruction of large defects of the scalp after wide excisional surgery of cutaneous malignancies is challenging. When the pericranium must be resected due to safety considerations, the exposed bone complicates reconstructive approaches. The objective was to develop an improved technique for reconstructive surgery of full-thickness scalp defects. Full-thickness scalp defects of up to 126 cm(2) in size with exposure of denuded bone were treated by partial removal of the outer table of the skull. The diploic space exposed by this treatment showed petechial bleeding and was covered with a dermal regeneration template (Integra, Integra Lifesciences Corp., Plainsboro, NJ). After transformation of the template by vascularization and by proliferation of fibroblasts, an ultrathin skin graft was transplanted onto the neodermis. Thirteen patients with cutaneous malignancies of the scalp were treated using this technique. The defects were transplanted within a median postoperative time period of 29 days (+/- 4 days) and showed good cosmetic results and stable scars. After a follow-up period of 6 months, no local recurrences were observed. This reconstructive procedure allows closure and rapid healing of large scalp defects in which the pericranium had to be resected.

The use of a bovine collagen construct for reconstruction of full-thickness scalp defects in the elderly patient with cutaneous malignancy.

Full-thickness defects of the scalp following cancer resection are reconstructive challenges when bone is exposed. Local, regional, and/or free tissue transfer have all been described for reconstruction when the pericranium is exposed. We examined the surgical outcomes from 23 patients who underwent placement of bovine collagen constructs. Thereafter, delayed skin grafting was performed. The average age of the patients was 70 years. All patients had one of the following: melanoma (n = 13) squamous cell carcinoma (n = 5), angiosarcoma (n = 2), basal cell carcinoma (n = 1), spindle cell carcinoma (n = 1), or malignant pilar tumor (n = 1). The average defect size was 51 cm, with a range of 9 cm to 169 cm. Average time between bovine construct placement and skin grafting was 30 days. Histologic studies demonstrated persistence of the construct and infiltration of nascent fibroblasts. Six patients had delayed healing due to microabscesses in the constructs. All wounds eventually healed. In the elderly, this is a simple method to treat full-thickness scalp defects.