Scalp Reconstruction using Dermal Induction Template: State of the Art and Personal Experience.

Abstract

The loss of skin envelope is a frequent and costly problem in health care. This article provides an overview on the state of the art in scalp reconstruction with dermal substitutes, as well as our personal experience of ten critical patients with non-melanoma skin cancer of the scalp. These patients were treated in a two-stage procedure by wide tumor excision, apposition of a dermal induction template (Hyalomatrix (R)) and successive skin grafting. Four patients underwent subgaleal tumor excision with preservation of the periosteum and six patients en bloc tumor excision together with the external cortical bone. A 10x10 cm template was used in all patients. Two weeks after demolition surgery, we observed neodermis formation. Results were documented by comparative photography, visual analogue scale for patient satisfaction, and Vancouver scar scale for evaluation of final graft characteristics. Patients were tumor-free during follow-up. The procedure achieved good scalp reshaping and graft scarring evolution. Patient satisfaction was high. Hyalomatrix (R) was effective for oncological scalp reconstruction in critical patients. It prepared the wound bed for graft take while awaiting histological diagnosis and confirmation of margin clearance. Further studies on dermal substitutes are needed to improve benefit in patients