Human Cadaveric Dermal Matrix for Management of Challenging Surgical Defects on the Scalp

Abstract

In patients with significant comorbidities, inability to tolerate extended surgical repairs, or inability to perform extensive wound care, human cadaveric dermal allografts can decrease operative time and minimize wound care complexity while providing an excellent aesthetic outcome in many cases. Shorter healing times than expected were also noted in a number of patients. The authors have indicated no significant interest with commercial supporters.

Reconstruction of Scalp Wounds with Exposed Calvarium Using a Local Flap and a Split-Thickness Skin Graft: Case Series of 20 Patients

“…Although it has been commonly assumed that all wounds of the scalp with underlying exposed bone should be repaired, even larger wounds of the scalp with exposed bone will typically eventually heal by second intention, although wound healing takes much longer if bone has been exposed at the base of the scalp wound. With lengthy exposure of the calvarium, osteomyelitis, although rare, is a concern . Bone necrosis due to desiccation without infection may also occur .…”

“…With lengthy exposure of the calvarium, osteomyelitis, although rare, is a concern . Bone necrosis due to desiccation without infection may also occur . In a large series examining second‐intention healing of wounds with exposed calvarium, 2.7% of patients experienced poor wound healing .…”

“…Also, previously irradiated sites may not be suitable for graft survival . Synthetic skin substitutes, cadaveric dermal matrix grafts, and bovine collagen constructs have been used to promote granulation tissue prior to skin graft placement . While the use of these materials may expedite wound healing, dermal matrix grafts are expensive and require additional clinic visits .…”

“…10 Bone necrosis due to desiccation without infection may also occur. 10 In a large series examining second-intention healing of wounds with exposed calvarium, 2.7% of patients experienced poor wound healing. 11 Difficulties in wound healing may become clinically problematic and may require additional biopsies to exclude recurrent or persistent tumor.…”

“…19 Synthetic skin substitutes, cadaveric dermal matrix grafts, and bovine collagen constructs have been used to promote granulation tissue prior to skin graft placement. 10,20,21 While the use of these materials may expedite wound healing, dermal matrix grafts are expensive and require additional clinic visits. 20 Artificial skin constructs typically require a two staged procedure and are placed after bone is manipulated to induce granulation tissue.…”