Dermal Substitute for Reconstruction of Large Full Thickness Scalp Defect: a Case of Dermal Regeneration without Removal of the Outer Table of the Skull

Aggressive neoplasms of the scalp need a wide and deep excision to obtain safe margins and tumor eradication [1]. These considerations sometimes lead to the inclusion of the periosteum as part of wide local excision. The consequence of large surgical excision of the scalp is the exposure of the skull bone with its poor vascularization, therefore a slow granulation and, eventually, a difficult healing by secondary intention. The exposed bone can be covered with local flaps but most often, this option, especially for large flaps, is not without complications (necrosis of the flaps, dehiscence, necessity of general anesthesia, etc.), hence free tissue transfer or use of dermal substitute are the only potential alternatives. Both these techniques have got the advantage to allow rapid coverage of larger surgical defects. On the other hand, they require a well vascularized recipient bed. Consequently, in such cases the outer table of the skull needs to be burred till bleeding is produced [2]. This procedure obviously complicates the reconstructive time, needing a general anesthesia, the presence of a neurosurgeon and increasing the patients’ morbidity. We successfully used a dermal substitute (acellular bovine tissue composed of native structurally intact collagen fibrils and elastin Matriderm® produced by Dr. Suwelack Skin & Health Care AG, Billerbeck, Germany) directly on the skull for reconstruction of the scalp following the excision of a sarcoma.