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Novel technique for reconstruction of full-thickness scalp defects has low morbidity
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A novel technique for large full-thickness scalp defects that can be performed on an outpatient basis with minimal wound care resulted in low morbidity, according to study results.
Researchers conducted a retrospective review of 10 patients (mean age, 71.5 years; eight men) who underwent reconstruction of large scalp defects between 2008 and 2014. The procedure included Integra bilayer wound matrix application followed by delayed split-thickness skin grafting. Mean time was 21 days between placement of the dermal regeneration template and skin grafting.
The patients had previous surgical excision of primary scalp lesions, with the most common lesion being squamous cell carcinoma, followed by malignant melanoma, basal cell carcinoma, microcystic adnexal carcinoma and atypical fibrox-anthoma. The defect mean surface area size was 63 cm2.
The patients had “excellent skin graft and wound closure outcomes,” the researchers wrote.
There was a 100% initial take of the skin graft to the defect site in nine of the patients, with one patient having a 95% to 100% initial take. Acceptable cosmetic results with adequate coverage of the wound bed occurred in all patients.
Postoperative radiotherapy was recommended for four patients, with two patients undergoing the intensity-modulated radiotherapy. One of the patients experienced radiotherapy-induced breakdown of 6-cm2 area of desquamation and cellulitis at 3.5 months following the radiotherapy treatment. After treatment with hyperbaric oxygen therapy and oral antibiotics, the wound resolved completely after 6 months.
“This technique provides the surgeon with an alternative to other reconstructive options, including microvascular free tissue transfer, for repair of large full-thickness scalp defects with excellent results,” the researchers concluded. “The procedure can be performed under sedation and local anesthesia for patients with risk factors for general anesthesia.” – by Bruce Thiel
Disclosure: The researchers report no relevant financial disclosures.
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