Placement of Dermal Regeneration Template on Fibrotic Dura

We report the case of a male presenting with a large, fungating Marjolin ulcer over a prior craniectomy defect that had undergone several attempts at reconstruction. On presentation, he had a large area of exposed, fibrotic dura that ultimately required excision of the outer layer prior to placement of Integra (Integra LifeSciences, Plainsboro, NJ) and subsequent split-thickness skin grafting. Although there have been four other reports of dermal regeneration templates being used on exposed dura, this is the first case report of one being used on exposed dura that required dural preparation prior to placement. We discuss our rationale for this method of reconstruction, the histology of dermal regeneration template incorporation, and why this approach was necessary to allow for incorporation in this patient.