Scalp Reconstruction With a Synthetic Dermal Substitute After Cylindroma Excision in Brooke-Spiegler Syndrome

Brooke-Spiegler syndrome (BSS) is a rare autosomal dominant condition characterized by multiple adnexal tumors, including cylindromas, most commonly affecting the scalp. Standard management involves surgical excision followed by reconstruction with split-thickness skin grafts (STSGs) or local flaps. However, STSGs introduce donor-site morbidity, have suboptimal color match, are prone to contraction, and preclude future hair grafting. Synthetic dermal substitutes have been used in combination with STSGs, but their use alone in BSS has not been described. We report the case of a 48-year-old woman with BSS and multiple medical comorbidities who presented with more than 60 painful scalp cylindromas. She underwent staged excision of lesions to the level of the periosteum. Reconstruction was performed using NovoSorb Biodegradable Temporizing Matrix (BTM) alone, without STSGs. The matrix demonstrated successful integration and progressive secondary epithelialization. Complete epithelialization occurred within several weeks following each excision stage, and no complications or malignant transformation were observed. The patient avoided donor-site morbidity and the additional operative time associated with STSGs. This case represents a likely first reported instance of single-stage reconstruction using BTM alone following scalp cylindroma excision in a patient with BSS. The outcome suggests that BTM can provide durable coverage and acceptable cosmetic results while reducing surgical burden in medically complex patients. BTM may be considered a practical alternative to traditional graft-based reconstruction in selected cases of extensive scalp involvement in BSS.