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Hostile Scalp Wound Reconstruction Using Acellular Dermal Matrix for Soft Tissue Augmentation.

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Acellular dermal matrix (ADM) aids complex adult scalp reconstruction in high-risk patients. This adjunct minimizes complications like hardware exposure in challenging wounds.

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Area of Science:

  • Plastic Surgery
  • Reconstructive Surgery
  • Biomaterials

Background:

  • Acellular dermal matrix (ADM) is established for scalp burn reconstruction.
  • Its use in high-risk adult patients with complex scalp wounds is less understood.
  • Previous studies primarily focused on pediatric populations.

Purpose of the Study:

  • To identify pre-operative factors influencing ADM use in adult complex scalp reconstruction.
  • To evaluate postoperative outcomes, including wound complications and reoperation rates.
  • To assess ADM's efficacy in "hostile" scalp wounds.

Main Methods:

  • Retrospective case series of nine adult patients undergoing scalp reconstruction with ADM.
  • Data collected from January 2017 to October 2018 by a single surgeon.
  • Included patients with prior craniotomies/craniectomies, exposed hardware, and radiation exposure.

Main Results:

  • Seven female patients with a median age of 64 years were included.
  • Six patients had prior craniotomies/craniectomies; four had exposed/infected hardware.
  • Median soft tissue defect size was 30 cm²; one patient required reoperation for osteomyelitis.

Conclusions:

  • Acellular dermal matrix (ADM) is a valuable adjunct for complex adult scalp reconstruction.
  • ADM can augment compromised scalp, especially over alloplastic materials, reducing hardware exposure.
  • Demonstrated utility in high-risk scalp wounds characterized by prior surgery, infection, and radiation.