Closure of a Large Scalp Defect Using External Tissue Expansion

Area of Science:

• Plastic Surgery
• Dermatology
• Oncology

Background:

• Scalp reconstruction presents challenges due to limited laxity and the hair-bearing nature of the tissue.
• Traditional methods like primary closure, secondary intention, free flaps, and skin grafting have limitations for large defects, often resulting in poor cosmetic outcomes.
• Dermatofibrosarcoma protuberans (DFSP) can require extensive resection, leading to significant scalp defects.

Purpose of the Study:

• To describe a novel approach for reconstructing a large scalp defect resulting from multiple resections of dermatofibrosarcoma protuberans.
• To evaluate the efficacy of Integra, Negative Pressure Wound Therapy (NPWT), and DermaClose continuous external tissue expansion for achieving primary closure and favorable cosmetic results in complex scalp reconstruction.

Main Methods:

• A patient with a large parietal scalp defect after DFSP resection underwent serial debridements.
• Integra (a dermal regeneration template) was applied to the exposed calvarium, followed by Negative Pressure Wound Therapy (NPWT).
• After granulation tissue formation, two DermaClose continuous external tissue expanders were used to gradually reduce the wound size, enabling primary closure.

Main Results:

• The combined use of Integra, NPWT, and DermaClose tissue expansion successfully facilitated the reduction of a large scalp defect.
• Primary closure of the wound edges was achieved, covering a significant area with hair-bearing scalp.
• The reconstruction resulted in satisfactory cosmetic outcomes for the patient.

Conclusions:

• This technique offers a viable solution for reconstructing large, complex scalp defects, particularly those arising from oncologic resections.
• The sequential application of Integra, NPWT, and continuous external tissue expansion can effectively manage exposed calvarium and facilitate defect closure.
• This approach provides a method to achieve functional and aesthetically pleasing scalp reconstruction, preserving hair-bearing skin.