Integra® dermal regeneration template for full thickness carcinologic scalp defects: Our 6 years’ experience retrospective cohort and literature review

Romano, Golda; Bouaoud, Jebrane; Moya‐Plana, Antoine; Benmoussa, Nadia; Honart, Jean-François; Leymarie, Nicolas

doi:10.1016/j.jormas.2020.06.016

Cited by 12 publications

(19 citation statements)

References 25 publications

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“…The treatment by DRT is recommended in the following cases: 1) elderly or extreme elderly patients which may present additional risk factor related to comorbidity [9,17,18] 2) in case of wide local excision (>4cm) [19][20][21] 3) in case of bone exposure resulting from the removal of the periosteum [8,9,22]; in this case it is recommended to drill the outer table to vascularize the DRT from the bone marrow [23] 4) in case of previous surgery with graft or flap failure or in case of recurrence of the neoplasm [9,24,25] 5) in case of previous radiation therapy (pre or postoperative irradiation at the surgical site) [26][27][28] 6) in patients with very aggressive cancer in which close postoperative clinical surveillance is deemed necessary. [17,21,24,27,29,30] There is also agreement among the authors that the use of the DRT is more economically advantageous than the cover with flaps [31] especially if the operated surface is greater than 120 square cm [23]. Some authors have proposed the use of the DRT with the one step technique without subsequent thin skin grafting, thus favoring healing by secondary intention [32].…”

Section: Discussionmentioning

confidence: 99%

Technical refinements in the use of dermal regeneration template in full thickness scalp defects after radical cancer surgery

M¹,

Castronovo²,

Teglas³

et al. 2021

Glob Surg

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Background:The incidence of scalp neoplasms is continuously increasing as a consequence of the progressive aging of the population. The need to perform a correct excision of scalp neoplasms often requires the removal of the entire skin, galeal and periosteum lining. The consequent complete uncovering of the thecal bone does not allow any type of local grafting and, in the past, has always involved the need to carry out the recovering using local or free flaps. The preparation of the local flaps generally involves large detachments of the scalp, which can cause severe complications of the haemorrhagic type, especially in elderly patients with anticoagulant or antiplatelet treatments. The realization of free flaps, on the other hand, involves a greater anesthetic effort and the creation of a further sacrifice in the donor site. Methods:The introduction of Dermal Regeneration Templates made it possible to undertake repairing techniques for full-thickness lesions of the scalp with the simple aid of local anesthesia without the need to suspend antiplatelet treatments. The interventions based on the use of Dermal Regeneration Templates are not complex, however they require particular and simple measures which, if not applied, lead to not entirely satisfactory results. This work describes a method of using Dermal Regeneration Templates in the repair of full-thickness lesions of the scalp that follows a rigorous protocol as result of constant internal review.In particular, we identified three details leading to better results:• continuous Ford interlocking suture with "double pass" in the DRT;• tie-over compression fixed by sutures anchored approximately 5-8 mm externally to the margins of the main suture (8 points);• antibacterial ointment sealing. Conclusions:In our opinion, a correct protocol concerning surgical techniques and dressing management allows the shortening of Dermal Regeneration Templates placing times from 6 to 4 weeks; better results in terms of percentage of area with good flourishness, less fluid collection under the Dermal Regeneration Templates and consequently the formation of a more homogeneous and better quality neoderm.

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Section: Discussionmentioning

confidence: 99%

Technical refinements in the use of dermal regeneration template in full thickness scalp defects after radical cancer surgery

M¹,

Castronovo²,

Teglas³

et al. 2021

Glob Surg

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“…Integra) followed by secondstage skin grafting has been shown. [109][110][111][112] Recent retrospective studies advocate for final…”

Section: Forehead and Scalp Defectsmentioning

confidence: 99%

“…[108][109][110][111] Recent retrospective studies advocate for final reconstruction with skin grafts 17 to 24 days following the placement of the regenerative dermal matrix. [109][110][111] A 2016 comparative study found no difference in healing or the formation of strong tissue when local or free flap reconstruction was compared with reconstruction with Integra þ skin graft for scalp defects with exposed bone. 108 However, on cost analysis, defects larger than 100 cm 2 reconstructed with free or local flap had twice as high final operative cost.…”

Section: Forehead and Scalp Defectsmentioning

confidence: 99%

“…Excellent cosmetic outcomes and low complication rates following the use of dermal allografts (i.e., Integra) followed by second-stage skin grafting has been shown. [108][109][110][111] Recent retrospective studies advocate for final reconstruction with skin grafts 17 to 24 days following the placement of the regenerative dermal matrix. [109][110][111] A 2016 comparative study found no difference in healing or the formation of strong tissue when local or free flap reconstruction was compared with reconstruction with Integra þ skin graft for scalp defects with exposed bone.…”

Section: Forehead and Scalp Defectsmentioning

confidence: 99%

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State of the Evidence for Facial Skin Cancer Reconstruction

et al. 2023

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This review provides a comprehensive presentation of the evidence available in facial reconstruction post-Mohs Micrographic Surgery. Given the large diversity in post-Mohs reconstruction, there are limited guidelines in the management of defects. The aim of the present work is to provide a review of the best evidence as it pertains to several considerations in facial reconstruction. Data suggests that Mohs Micrographic Surgery and many reconstructive procedures can be performed as outpatient procedures under local anesthesia, with narcotic pain medication only given in certain patient populations following a minority of reconstructive procedures. Perioperative and topical antibiotics are generally not indicated. Aspirin and Warfarin can generally be continued for most reconstructive procedures, but clopidogrel and novel anticoagulants may predispose to increased bleeding complications. Delayed reconstruction appears to be safe, although data is discordant on this topic. No specific wound closure technique or suture choice appears to be consistently superior. Given the lack of robust comparative studies, consistent methodology, and variable defect sizes/ locations, no robust evidence-based guidelines can be generated for reconstruction techniques of facial subsites.

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“…2 However, immediate coverage of large defects (>20 cm 2 ) with calvaria exposure may be challenging for the dermatologic surgeon. 3,4 We describe a solution to obtain immediate coverage of a large defect with periosteum removal on the scalp (Figure 1) by using bone burring and the application of a Dermal Regeneration Template [(DRT) Integra LifeSciences Corp, NJ], a bilaminar membrane composed of a layer of bovine collagen with shark glycosaminoglycan, covered with a silicone outer layer 5 that prepares the tissue for the application of a split-thickness skin graft at a later second operation. This technique is especially useful on the scalp where the wound bed is not well-vascularized 4 (see Supplemental Digital Content 1 , video S1, http://links.lww.com/DSS/B33, with an example of this technique in the repair of a large defect due to a desmoplastic melanoma on the scalp).…”

mentioning

confidence: 99%

Coverage of Large Bone-Exposed Scalp Defect With Bone Burring Followed by Dermal Regeneration Template and Split-Thickness Grafting

et al. 2022

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wrap, and this is kept on for another week. Anecdotally, it appears that the dehiscence rate with this is lower than when allowing patients to change their bandage and wrap their legs themselves.In our experience, DORFs provide an effective and reproducible reconstructive technique for small-to medium-sized leg defects. Our study is limited by its retrospective nature, the lack of a comparison repair group, and not tracking specific factors that might contribute to dehiscence in any given patient. These are somewhat mitigated by the relatively large number of patients, which highlights the reproducibility of the repair, and the relatively low incidence of complications. Proper patient selection based on defect size and tissue laxity is critical, as is proper flap design and execution to ensure that secondary defects close readily along least-tension lines and that triangles are properly transposed.

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Integra® dermal regeneration template for full thickness carcinologic scalp defects: Our 6 years’ experience retrospective cohort and literature review

Cited by 12 publications

References 25 publications

Technical refinements in the use of dermal regeneration template in full thickness scalp defects after radical cancer surgery

Technical refinements in the use of dermal regeneration template in full thickness scalp defects after radical cancer surgery

State of the Evidence for Facial Skin Cancer Reconstruction

Coverage of Large Bone-Exposed Scalp Defect With Bone Burring Followed by Dermal Regeneration Template and Split-Thickness Grafting

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