Reconstruction of full thickness scalp defects after tumor excision in elderly patients: Our experience with Integra dermal regeneration template

Background: Scalp reconstruction after wide tumor excision is particularly challenging. Free tissue transfers, local flaps, or skin grafts can be used but present some disadvantages especially with old patients with local advanced cancers, systemic diseases and in patients with a prior history of recurring scalp skin cancers in which the risk of burying a recurring tumor with a flap is likely. The Authors expose their early experience with Integra® dermal regeneration template for scalp reconstruction after scalp tumor excision. Methods: Eight patients with primary or secondary scalp tumor underwent a first surgical procedure under local anaesthesia for tumor removal and Integra® positioning followed by a second operation performed three weeks later to reconstruct the defect by removing the superficial silicon layer of Integra® and by covering the defect with a split thickness skin graft. The average surface area of the defect was 143.27 cm2. The average operating time was 30.4 minutes for the first operation and 45.6 minutes for the second operation. In six cases Integra® was grafted as a classic full-thickness skin graft. In the remaining two cases the Integra® template was meshed. The artificial derma was attached to the edge of the wound by either sutures or staples. Results: There was a full graft take on all cases. The mean follow-up was 24 months. In two cases we were able to detect early tumor recurrence two months after the operation. Satisfactory cosmetic and functional results were obtained in all patients. Conclusions: In the scalp defect reconstructions after tumor excision, Integra® allows to obtain a thicker and more durable coverage than skin graft on the skull, allowing to detect a tumor recurrence earlier than a flap reconstruction with no risk of burying an eventual underlying residual tumor. These operations are performed under local anaesthesia and are therefore suitable for elderly patients