The Use of Integra Dermal Regeneration Template Versus Flaps for Reconstruction of Full-Thickness Scalp Defects Involving the Calvaria: A Cost–Benefit Analysis

Abstract

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.

Macrophages significantly enhance wound healing in a vascularized skin model

“…Dermal equivalents are used as off‐the‐shelf products in clinics such as MatriDerm®, Integra™, and DermaGraft®. These grafts combine autologous dermal fibroblasts and matrices based on various artificial, natural and synthetic materials, respectively . Combinations of epidermal and dermal grafts include PermaDerm™ and DenovoSkin, which are based on natural scaffold materials, fibroblasts and keratinocytes covering superficial wounds .…”

“…These grafts combine autologous dermal fibroblasts and matrices based on various artificial, natural and synthetic materials, respectively. [8][9][10][11][12] Combinations of epidermal and dermal grafts include PermaDerm™ and DenovoSkin, which are based on natural scaffold materials, fibroblasts and keratinocytes covering superficial wounds. 13 Issues that remain to be addressed include the risk of infection, poor adhesion and the temporary nature of the application.…”

The Basics of Integra Dermal Regeneration Template and its Expanding Clinical Applications

“…Despite its FDA approval for burns and diabetic foot ulcers, Integra has found increasing use all over the body for coverage of wounds that are not amenable to direct skin grafting. 6,7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]…”

“…The most widely studied role for Integra in the head and neck has been for coverage of full-thickness scalp wounds. [22][23][24] In a review of 34 studies, 32 showed success rates > 90%, with wounds described as large at 610 cm 2 . 23 Within these studies, the use of burring the outer table was frequently described to improve graft vascularization over denuded calvarium.…”

“…In a comparative cost analysis of patients with fullthickness scalp defects with exposed denuded calvarium treated with Integra or flap reconstruction, the overall hospital costs were found to have no significant difference, with Integra-based reconstruction being more cost effective in cases of wounds > 100 cm 2 . 24 In other areas of head and neck reconstruction, Integra has been described in case reports to augment local and free flap reconstruction after tumor excision. Patel et al describe its use for the lining of an orbital exenteration defect.…”