Reconstruction of complex full thickness scalp defects after dog bite injuries using Dermal Regeneration Template (Integra): Case report and literature review

Publication date: Available online 4 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Vanessa Watts, Mikhail Daya Attie, Shawn McClure

Abstract

Purpose

The purpose of this article is to review the current applications of Dermal Regeneration Templates in reconstruction of full thickness scalp defects, most commonly resulting from oncologic surgery, and demonstrate its success in reconstruction of a complex full-thickness scalp defect resulting from a dog bite injury.

Materials and Methods

A systematic review conforming to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines was completed. A PubMed search was completed using key terms including Integra, dermal regeneration template, full-thickness scalp defects, dog-bite injuries, and scalp. Eligible articles were selected based on characteristics of size of defects, procedural protocol, and reconstruction modalities. Outcomes reported were based on reports of follow-up, complications, and percent graft take. The case report presents reconstruction of a complex full-thickness scalp defect secondary to a dog-bite injury with a Dermal Regeneration Template (DRT).

Results

Fifteen articles were included. Reported ages ranged from 2 to 93 years of age. Mean defect size ranged from 6 to 610cm² with 66% of defects averaging more than 50cm2.All articles reported the two stage approach to Integra-based reconstruction with follow-up ranging from 5-23 months with only two articles reporting less than 90% graft take.

Conclusions

Acellular dermal matrix provides an alternative reconstructive mechanism to free tissue transfer and flap reconstruction, and offers a unique advantage in the medically complex patient, as well as in pediatric and geriatric populations. Successful Integra-based reconstruction of full-thickness complex scalp defects is well reported in the literature in relation to reconstruction of Moh's surgical defects as well as burns of the trunk and extremities; however, reports of reconstruction of post traumatic soft tissue defects of the head and neck is limited. Based on the reported successes from the reviewed literature, and the clinical outcome of the reported case, we believe Integra to be a valuable reconstructive tool in the algorithm for repair of post-traumatic full-thickness complex scalp defects when used appropriately.

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