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Original Investigation | Journal Club

Reconstruction of Full-Thickness Scalp Defects Using a Dermal Regeneration Template

Matthew A. Richardson, MD1; Jessica P. Lange, MD1; J. Randall Jordan, MD1
[+] Author Affiliations
1Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson
JAMA Facial Plast Surg. 2016;18(1):62-67. doi:10.1001/jamafacial.2015.1731.
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Importance  Large full-thickness scalp defects pose a reconstructive problem and commonly require microvascular free flap reconstruction.

Objective  To describe a novel and effective reconstructive technique for full-thickness scalp defects that can be performed quickly without general anesthesia or free flap reconstruction.

Design, Setting, and Participants  A retrospective review of 10 patients at a single medical center who underwent surgical resection of a cutaneous lesion. Reconstruction of the large scalp defects included application of Integra bilayer wound matrix followed by delayed split-thickness skin grafting from January 1, 2008, to December 31, 2014. Patients ranged in age from 50 to 87 (mean, 71.5) years; 8 (80%) were men. Mean duration of follow-up was 481.1 days (range, 41-1199 days).

Main Outcomes and Measures  Skin graft viability and adherence to underlying tissue (take) and postoperative complications.

Results  The 10 patients in this study had excellent skin graft and wound closure outcomes. Nine patients showed a 100% initial take of the skin graft to the defect site. Only 1 patient showed a 95% to 100% initial take. Adequate coverage of the wound bed was achieved with acceptable cosmetic results. Two patients underwent postoperative intensity-modulated radiotherapy. One of these patients experienced radiotherapy-induced wound breakdown 3½ months after completion of therapy, which resolved completely after more than 6 months.

Conclusions and Relevance  This novel technique for reconstruction of large full-thickness scalp defects has low morbidity and can be performed on an outpatient basis with minimal wound care. The technique provides the surgeon with an alternative to other reconstructive options, including microvascular free tissue transfer, for repair of large full-thickness scalp defects. The procedure has excellent results and can be performed under sedation and local anesthesia, which avoids the risks associated with general anesthesia.

Level of Evidence  4.

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Figure.
Reconstructive Technique for Full-Thickness Scalp Defects

A, Removal of the outer table of calvaria. B, Semipermeable silicone layer of the Integra bilayer wound matrix in place. C, Dual-layer dressing in place and secured with staples. D, One-month postoperative result with 100% skin graft take.

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