Reconstruction of full-thickness scalp defects often poses various challenges depending on the complexity and characteristics of the wound as well as independent patient health factors. Despite a range of reconstructive options ranging from primary closure, adjacent tissue transfer, and autografts to free flap reconstruction, there is no universally adopted decision algorithm.
Integra, an acellular matrix composed of crosslinked bovine collagen and glycosaminoglycan covered by a silicone membrane, is widely used for scalp reconstruction and has been shown to produce excellent functional and cosmetic results.
The featured case involves staged scalp reconstruction utilizing the Integra bilayer matrix wound dressing for an elderly immunocompromised patient presenting with two adjacent full-thickness scalp defects resulting in exposed calvarial bone over the vertex. The discussion centers on determining the most optimal scalp reconstructive option and exploring the treatment algorithm used at our institution. Furthermore, application of Integra for calvarial bone coverage will be discussed.
Geoffrey G. Hallock, MD Plastic Surgery Consultant Sacred Heart Campus, St. Luke’s Hospital Allentown, Pennsylvania
In this case, Dr. Hallock performs a right forearm squamous cell carcinoma excision followed by a split-thickness skin graft from the thigh. It was filmed in Honduras on a surgical mission with the World Surgical Foundation.
Mark N. Perlmutter, MS, MD, FICS, FAANOS
Carolina Regional Orthopaedics
The patient in this case is a 1-year-old female with complex syndactyly of the right hand and simple syndactyly of the left hand. Here, Dr. Rao and Dr. Perlmutter release both sides, with the right side involving a full-thickness skin graft taken from the patient’s groin crease. This case was filmed during a surgical mission with the World Surgical Foundation in Honduras.
Daniel N. Driscoll, MD, FACS
Division of Plastic, Reconstructive, and Laser Surgery
Shriners Hospitals for Children – Boston
Lisa Gfrerer, MD, PhD
Harvard Plastic Surgery Combined Residency Program
Robert J. Dabek, MD
Massachusetts General Hospital
This case focuses on the treatment of an 8-year-old male with scars from burn wounds he sustained at the age of 2 that have resulted in areas of scar contracture, stiffness, and hypopigmentation. Watch Dr. Daniel Driscoll perform a scar release, a split-thickness skin graft, a permanent pigment transfer, and fractional CO2 laser resurfacing.