title: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Plastic Reconstructive Surgery, University of Udine, and Department of Neurosurgery, Azienda Ospedaliero-Universitaria S. M. della Misericordia, Udine, Italy. emanuele.rampino@uniud.it
authors.forename: Emanuele Rampino
authors.initials: ER
authors.lastname: Cordaro
authors.forename: Sarah
authors.initials: S
authors.lastname: Calabrese
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Faini
authors.forename: Bruno
authors.initials: B
authors.lastname: Zanotti
authors.forename: Angela
authors.initials: A
authors.lastname: Verlicchi
authors.forename: Pier Camillo
authors.initials: PC
authors.lastname: Parodi
mesh_terms: D000063:Accidents, Traffic; D001860:Bone Plates; D002809:Chondroitin Sulfates / Q000627:therapeutic use; D003094:Collagen / Q000627:therapeutic use; D006259:Craniocerebral Trauma / Q000601:surgery*; D017886:Durapatite / Q000627:therapeutic use; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012535:Scalp / Q000601:surgery*; D012886:Skull / Q000601:surgery*; D013524:Surgical Flaps; D014025:Titanium; D055815:Young Adult
chemical_list: C114835:integra artificial skin; D002809:Chondroitin Sulfates; D003094:Collagen; D017886:Durapatite; D014025:Titanium