(CS-024) Direct application of dermal regeneration template on scalp wounds with denuded calvarium
Co-Author(s):
Samuel Corey, M.D.; Michael Keyes, M.D.; Bradon Wilhelmi, M.D.
Introduction: The use of dermal regeneration templates in “ungraftable” wound beds, such as those with denuded tendon, cartilage, or bone, is well-described. In full-thickness scalp wounds where the size of the denuded calvarial defect can be large,1 most reports describe burring of the outer table as a preliminary step to the application of dermal regeneration template.2-4 The purpose of this study is to report the successful use of a dermal regeneration template* in full-thickness scalp wounds devoid of pericranium through direct application on cortical bone without preliminary burring of the outer cortex.
Methods: A series of four consecutive full thickness scalp wounds devoid of pericranium were treated with direct application of Integra on intact cortex. The defects arose following extirpation for locally advanced skin malignancies in 2 patients, revision of a prior craniotomy wound in 1 patient, and resurfacing of a fourth degree scalp burn in 1 patient. The size of the avascular segments ranged from 25 cm2 to 120 cm2. After a period of 3-4 weeks, split thickness skin grafting was performed. Follow up ranged from 3-6 months following skin grafting.
Results: The percent take of subsequent skin grafting was excellent, ranging from 85% to 100%. In the case of 85% graft take, partial failure of skin grafting with dermal regenerate template* was later determined to be secondary to undiagnosed underlying osteomyelitis associated with a prior bone flap. We noted that take was more successful in acute wounds (Figure 1) than in subacute or chronic wounds.
Discussion: Dermal regeneration templates* can be used directly on cortical bone without preliminary burring of the outer table, particularly in acute wounds. This may avoid the potential morbidity of thinning the calvarial bone while preserving this step as a backup option.
Trademarked Items: *Integra
References: References 1. Gonyon DL, Jr., Zenn MR. Simple approach to the radiated scalp wound using INTEGRA skin substitute. Ann Plast Surg. 2003;50(3):315-320. 2. Yeong EK, Huang HF, Chen YB, Chen MT. The use of artificial dermis for reconstruction of full thickness scalp burn involving the calvaria. Burns. 2006;32(3):375-379. 3. Komorowska-Timek E, Gabriel A, Bennett DC, et al. Artificial dermis as an alternative for coverage of complex scalp defects following excision of malignant tumors. Plast Reconstr Surg. 2005;115(4):1010-1017. 4. Magnoni C, De Santis G, Fraccalvieri M, et al. Integra in Scalp Reconstruction After Tumor Excision: Recommendations From a Multidisciplinary Advisory Board. J Craniofac Surg. 2019;30(8):2416-2420.