Reconstruction of scalp defects with exposed bone after surgical treatment of basal cell carcinoma: the use of a bilayer matrix wound dressing

Abstract

Treatment of scalp defects after tumor resection or traumatic events is a challenging problem. Large defects with loss of soft tissue down to the bone require complex reconstructive options, including tissue expansion, local and distal scalp flaps, and free split thickness skin graft. Nonetheless, these techniques are often disfiguring and are limited by the relatively poor elasticity and vascularity of scalp tissues after recurrent resection or previous irradiation. Moreover, comorbid conditions among elderly patients often limit anesthetic tolerance and the use of distant flaps. We report a case of a 75-year-old woman with large tissue loss and bone exposure after Mohs micrographic surgery of basal cell carcinoma of the scalp which was successfully rebuilt through the use of a skin substitute. We describe the uncommon use of a bilayer matrix wound dressing as a single procedure option for the management of full-thickness scalp defects with bone exposure.

Integra-based Reconstruction of Large Scalp Wounds: A Case Report and Systematic Review of the Literature

“…11,21,27,39–41 Five of the 6 studies did not apply a skin graft, 11,21,39–41 while one applied both Integra and skin graft in the same procedure. 27 One case report performed one-stage reconstruction of a defect ≥100 cm 2 , reporting a minor infection in the postoperative period.…”

“…10,12,14,15,17–20,22–24,27,28,30–34,36–38,40 Percent take was >90% in studies not employing bone burring. 9,11,12,16,17,29,35,39,41 …”

“…The remaining 22 articles using unfenestrated Integra reported percent take ranging from 50% to 100%. 9–11,14–16,18–20,22–25,27,31–35,37,39,42 Fung et al 37 reported hematoma formation under unfenestrated Integra resulting in 90% graft take.…”

“…Accordingly, 6 studies employed a single-stage reconstructive approach, ranging in publication date from 2004 to 2015. 11,21,27,39–41 Navsaria et al 11 were the first to describe single-stage Integra reconstruction in a patient with a full-thickness burn of the scalp, ear, face, and left arm. Foregoing a skin graft altogether, Navsaria et al 11 applied Integra followed by hair micrografting directly into the dermal regeneration template 12 days later.…”

Management of skin defect following resection of Stage IV scalp melanoma: A case report

“…Giant melanomas are treated via surgical excision, but leaves behind a large post-operative defect that can extend down to the bony scalp. Due to the distinctive features of this anatomic site, reconstruction of the scalp is a challenge for surgeons [3].…”