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Reconstruction of Facial and Scalp Defects Using a Dermal Regeneration Template: A Retrospective Cohort Study
Martin Buta
*, Alexis Buckley, Branko Bojovic
Surgery, Div. of Plastic & Reconstructive Surgery, Massachusetts General Hospital, Boston, MA
Background: Facial and scalp defects resulting from trauma, burns, or oncologic surgery often require skin grafts or flaps for wound coverage. Acellular dermal matrices have been increasingly utilized as an alternative to these approaches in select cases such as when autologous tissue is suboptimal or unavailable for reconstruction or a patient’s comorbidities preclude a more complex approach. This study presents our experience at a major academic hospital with single-stage reconstruction of facial and scalp defects using Integra bilayer dermal regeneration template with healing by secondary intention.
Study Design: A retrospective review of the electronic medical record was carried out on all patients 18 years and older with facial or scalp defects resulting from trauma or oncologic surgery who underwent reconstruction with Integra Bilayer Wound Matrix (IBWM) by the senior surgeon between 2016 and 2024. Patient demographics, indication for reconstruction, wound characteristics, complications, and post-operative course were analyzed. A successful outcome was defined as >95% re-epithelialization after single-stage wound matrix application without the need for additional coverage procedures. Primary outcomes of interest included time to wound closure, reoperation rate, and the use of skin grafting, local tissue rearrangement, flap, laser therapy, or dermal filler.
Results: We identified 49 patients (38.8% male, 61.2% female; mean age: 65.7±14.1 years, range: 22.8-95.4) who underwent reconstruction at 52 different facial and scalp sites. The mean wound area treated was 17.5±25.5 cm
2 (range: 1.8-150.0). Forty-one (78.9%) of all defects were reconstructed as an outpatient procedure and were successfully closed with a single-stage application of IBWM. The primary indication for surgery was oncologic reconstruction (n=47, 90.4%) followed by trauma (n=2, 3.8%) and exposed hardware (n=2, 3.8%). For single-stage reconstruction with IBWM, scalp wounds took an average of 159±133 days (range 52-505) to close while facial wounds took an average of 81±40 days (range 44-210) to close. No patients required a locoregional flap due to incomplete re-epithelialization. To improve cosmesis after wound closure, 3 (5.8%) sites required local tissue rearrangement, 5 (9.6%) sites required one to three laser treatments for scar resurfacing, and 1 (1.9%) site required three treatments with dermal filler injections. No complications (infection, hematoma, dehiscence) were reported.
Conclusions: Integra can be safely and reliably used for outpatient single-stage reconstruction of select full-thickness post-oncologic facial and scalp defects.
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