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. 2024 Dec;28(4):1635-1642.
doi: 10.1007/s10006-024-01292-5. Epub 2024 Oct 4.

One-stage scalp reconstruction using single-layer dermal regeneration template and split-thickness skin graft: a case series

Ciro Emiliano Boschetti  1 , Giorgio Lo Giudice  2 , Samuel Staglianò  1 , Annalisa Pollice  1 , David Guida  3 , Roberta Magliulo  1 , Giuseppe Colella  1 , Fabrizio Chirico  1 , Mario Santagata  1
Affiliations

One-stage scalp reconstruction using single-layer dermal regeneration template and split-thickness skin graft: a case series

Ciro Emiliano Boschetti et al. Oral Maxillofac Surg. 2024 Dec.

Abstract

Purpose: Scalp full-thickness defects reconstruction following the resection of skin carcinoma poses significant challenges due to scalp anatomy complexity and limited vascularity. Despite various techniques available, including tissue expansion and local flaps, no single method stands as the gold standard. Moreover, cases requiring adjuvant radiotherapy further complicate reconstruction, demanding durable solutions. This study explores the efficacy of Integra® Dermal Regeneration Template Single Layer (Integra DRTSL) followed by split-thickness skin grafting (STSG) in one-stage scalp reconstruction post oncologic resection.

Methods: A retrospective analysis was conducted on patients undergoing this procedure from January 2020 to October 2023. Surgical outcomes, including graft take rates, complications, and adjuvant therapy tolerability, were assessed.

Results: Results demonstrated successful reconstruction in the majority of cases, with a complete graft take rate of 77% and minimal complications. Notably, the single-stage approach facilitated timely initiation of adjuvant therapy, crucial for oncologic management. Healing times were notably reduced (< 60 days), enabling early radiotherapy commencement. No local recurrences were observed during the 16-month follow-up.

Conclusion: The use of Integra DRTSL with STSG in one-stage reconstruction presents a promising alternative, offering optimal cosmetic and functional outcomes with low complication rates. This approach streamlines the reconstruction process, ensuring timely adjuvant therapy initiation and maximizing patient outcomes, especially in the context of scalp cutaneous tumors requiring radiotherapy.

Clinical trial number: This research was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of University of Campania "Luigi Vanvitelli" (protocol code N. 0013333, 29 April 2021).

Keywords: Cutaneous malignancies; Dermal regeneration template; Head and neck surgery; Scalp reconstruction; Skin carcinomas.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Invasive squamous cell carcinoma of the scalp
Fig. 2
Fig. 2
Tumor resection with removal of the periosteum underlying the calvaria
Fig. 3
Fig. 3
A polyurethane template was used to guide the cutting of the Integra DRTSL to the desired size
Fig. 4
Fig. 4
Placement of Integra DRTSL in the wound bed and its fixation by Vicryl sutures
Fig. 5
Fig. 5
The STSG is placed and secured to the wound bed by rapid Vicryl sutures
Fig. 6
Fig. 6
Clinical follow-up 12 months after surgery
Fig. 7
Fig. 7
Malignant melanoma of the scalp
Fig. 8
Fig. 8
Resection of the tumor with a scalp wound surface of about 91 cm2
Fig. 9
Fig. 9
One-stage reconstruction with Integra DRTSL and overlying STSG sutured at the wound edges using skin staples and Vicryl sutures
Fig. 10
Fig. 10
Clinical follow-up 6 months after surgery
See this image and copyright information in PMC

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