Hair-bearing scalp reconstruction using a dermal regeneration template and micrograft hair transplantation

The scalp has traditionally presented a challenge to the reconstructive surgeon. Although a variety of techniques exists for providing stable coverage to the cranium that has become exposed secondary to trauma, infection, or surgical ablation, these techniques tend to require multiple operations and a significant time commitment on the part of the patient and the surgeon. Unfortunately, most if not all of these techniques are unable to recreate the appearance of natural-appearing hair on the reconstructed scalp. We present our unique experience utilizing a tissue-engineered dermal regeneration template for reconstruction of the traumatized scalp. Once vascularized and skin grafted, the neodermis received approximately 1600 microfollicular hair grafts, which resulted in a pleasing esthetic outcome. In this case, a 50-year-old man suffered a significant degloving of the posterior portion of the scalp. The area of exposed periosteum/galea was covered acutely with Integra dermal regeneration template, followed by skin grafting 2 weeks later. Since the patient refused tissue expansion reconstruction, a trial of hair micrografting (100 grafts) into the Integra was performed, with good results. Two subsequent sessions of 800 grafts placed also had good results. This report represents the first use of sequential hair micrografting into Integra dermal regeneration template to reconstruct hair-bearing scalp. Application of a dermal regeneration template with a thin split-thickness skin graft followed by sequential hair micrografting is a viable alternative for hair-bearing scalp reconstruction in cases where traditional methods (eg, tissue expansion, microvascular free tissue transfer) are unavailable or undesirable.