Method to thicken the scalp in calvarian reconstruction

Abstract

Background: Scalp reconstruction has always been a challenging task. In our case, we report the use of INTEGRA Dermal Regeneration Flap, together with a cranioplasty for complex scalp defect. We have obtained not only an appropriate coverage of the cranial bone, but also an optimal aesthetic result.

Method: We present a 24-year-old patient with a history of severe cranial trauma with sinking of the frontal bone with dural laceration and large bilateral frontal lacerocontusive focus. First, he had undergone reconstruction with the aid of autologous bone, metallic mesh, and titanium plates at a different clinical center. He arrived to our attention with exposure of the fixation devices, as well as part of the titanium plate used for the primary reconstruction. His general conditions could not allow a complex reconstructive procedure such as microsurgical flaps. The use of INTEGRA allowed us to reach the goal of a good and appropriate reconstruction, without exposing the patient to a higher-risk procedure. After the creation of a custom-made cranial implant in porous hydroxyapatite, the patient has undergone cranial bone remodeling to reach a homogeneous contour of the forehead profile. After the positioning of the implant, a single-layer INTEGRA regeneration template has been placed between the implant itself and the hypotrophic and thinned skin layer.

Conclusions: The postoperative result after 16 months allowed us to observe a normal forehead profile with a normal thickness, good skin texture, and well-hidden scars.