BackgroundINTEGRA® Dermal Regeneration Template is a well-known and widely used acellular dermal matrix. Although it helps to solve many challenging problems in reconstructive surgery, the product cost may make it an expensive alternative compared to other reconstruction procedures. This retrospective study aims at comparing INTEGRA-based treatment to flap surgery in terms of cost and benefit.Patients and MethodsWe considered only patients treated for scalp defects with bone exposure in order to obtain two groups as homogeneous as possible. We identified two groups of patients: 17 patients treated with INTEGRA and 18 patients treated with flaps. All patients were admitted in our institution between 2004 and 2010, and presented a defect of the scalp following trauma or surgery for cancer, causing a loss of the soft tissues of the scalp with bone exposure without pericranium. To calculate the cost in constant euros of each treatment, three parameters were evaluated for each patient: cost of the surgical procedure (number of doctors and nurses involved, surgery duration, anesthesia, material used for surgery), hospitalization cost (hospitalization duration, dressings, drugs, topical agents), and outpatient cost (number of dressing changes, personnel cost, dressings type, anti-infective agents). The statistical test used in this study was the Wilcoxon Mann–Whitney (α = 0.05).ResultsNo significant difference was characterized between the two groups for gender, age, presence of diabetes, mean defect size, and number of surgical procedures. All patients healed with good quality and durable closure. The median total cost per patient was €11,121 (interquartile range (IQR) 8327–15,571) for the INTEGRA group and €7259 (IQR 1852–24,443) for the flap group (p = 0.34). A subgroup of patients (six patients in the INTEGRA group and five patients in the flap group) showing defects larger than 100 cm2 were considered in a second analysis. Median total cost was €11,825 (IQR 10,695–15,751) for the INTEGRA group and €23,244 (IQR 17,348–26,942) for the flap group.ConclusionBoth treatments led to a good healing of the lesions with formation of soft and resistant tissue. No significant difference was characterized between the two groups for days of hospitalization and costs. In cases of patients with defects larger than 100 cm2 for whom major surgery is needed, the treatment with INTEGRA seemed to be less expensive than the treatment with free flaps or pedicle flaps.Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the A5 online Instructions to Authors.www.springer.com/00266.

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Considering that at the sixth clinical follow-up the patient was alive and disease free at 50 months after surgery, the chosen treatment has proved successful.

BACKGROUND. The reports in the literature indicate that extraocular sebaceous carcinoma (SC), in contrast to orbital SC, is less aggressive and rarely metastasizes. METHODS. Of 2422 epithelioma cases observed over 10 years, 8 (0.33%) resulted as histologically proven SCs, all of which were located in the head. RESULTS. The clinical behavior of these tumors was observed by following patients for an average period of 50 months. Three of the tumors originated from the orbital region and five from other areas of the head (extraocular). In one case, the SC was associated with renal carcinoma (Muir-Torre syndrome). None of the orbital tumors metastasized, whereas two of the five cases of extraocular carcinoma metastasized to the locoregional lymph nodes. CONCLUSION. It should be stressed that in this case study aggressive biologic behavior was observed in carcinoma arising from extraorbital areas.

It should be stressed that in this case study aggressive biologic behavior was observed in carcinoma arising from extraorbital areas.