Removal of the outer table of the skull for reconstruction of full-thickness scalp defects with a dermal regeneration template.
BACKGROUND
The reconstruction of large defects of the scalp after wide excisional surgery of cutaneous malignancies is challenging. When the pericranium must be resected due to safety considerations, the exposed bone complicates reconstructive approaches.


OBJECTIVE
The objective was to develop an improved technique for reconstructive surgery of full-thickness scalp defects.


METHODS
Full-thickness scalp defects of up to 126 cm(2) in size with exposure of denuded bone were treated by partial removal of the outer table of the skull. The diploic space exposed by this treatment showed petechial bleeding and was covered with a dermal regeneration template (Integra, Integra Lifesciences Corp., Plainsboro, NJ). After transformation of the template by vascularization and by proliferation of fibroblasts, an ultrathin skin graft was transplanted onto the neodermis.


RESULTS
Thirteen patients with cutaneous malignancies of the scalp were treated using this technique. The defects were transplanted within a median postoperative time period of 29 days (+/- 4 days) and showed good cosmetic results and stable scars. After a follow-up period of 6 months, no local recurrences were observed.


CONCLUSIONS
This reconstructive procedure allows closure and rapid healing of large scalp defects in which the pericranium had to be resected.
Koenen
Wolfgang
W
Department of Dermatology, University Medical Center Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, Germany. wolfgang.koenen@haut.ma.uni-heidelberg.de
Goerdt
Sergij
S
Faulhaber
Jörg
J
D000368:Aged; D000369:Aged, 80 and over; D002809:Chondroitin Sulfates; D003094:Collagen; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012535:Scalp / Q000601:surgery*; D012878:Skin Neoplasms / Q000601:surgery*; D016038:Skin Transplantation; D017768:Skin, Artificial; D012886:Skull / Q000601:surgery; D014945:Wound Healing; D014947:Wounds and Injuries / Q000601:surgery
C114835:integra artificial skin; D002809:Chondroitin Sulfates; D003094:Collagen