title: Removal of the outer table of the skull for reconstruction of full-thickness scalp defects with a dermal regeneration template.
abstract: 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.
authors.affiliation: Department of Dermatology, University Medical Center Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, Germany. wolfgang.koenen@haut.ma.uni-heidelberg.de
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Koenen
authors.forename: Sergij
authors.initials: S
authors.lastname: Goerdt
authors.forename: Jörg
authors.initials: J
authors.lastname: Faulhaber
mesh_terms: 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
chemical_list: C114835:integra artificial skin; D002809:Chondroitin Sulfates; D003094:Collagen