Screw fixation of dermal regeneration template for scalp reconstruction

Despite many advances in reconstructive techniques, the full-thickness scalp defect remains a difficult problem for the reconstructive surgeon. Patient and disease-specific factors occasionally make reconstruction with a dermal regeneration template (DRT) an attractive option when other methods are less advised. Although the applicability of dermal regeneration templates has been well elucidated, the method of DRT immobilization has not been standardized. Given the difficulty of adherence and subsequent infiltration of host cells into the DRT from the underlying bone due to seroma, hematoma, or shearing forces, we propose a screw and bolster system for DRT immobilization. We present a series of 13 patients with full-thickness scalp loss who underwent reconstruction with DRT and a subsequent split-thickness skin graft. All 13 patients were treated with the screw-bolster method of DRT fixation before a vacuum-assisted closure dressing. The average surface area of the defect was 96 cm. The mean time interval between the application of DRT and skin graft was 28 days. At a mean of 9-month follow-up, all patients achieved a well-vascularized neodermis, and progressed to complete, stable wound healing following application of a split-thickness skin graft. We propose that a screw-bolster system of fixation is a safe and effective method of immobilizing DRT in full-thickness scalp defects.