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Direct application of Integra bilayer matrices on bare calvarium without preliminary burring: a clinical and histologic study of efficacy
Michael Keyes, MD.; Joshua Choo, MD.
University of Louisville
2022-01-30
Presenter: Michael Keyes, MD
Affidavit:
Bradon Wilhelmi
Director Name: Bradon Wilhelmi
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Purpose: The use of dermal regeneration templates in scalp wounds devoid of pericranium is well-described, with reports of wounds as large as 400 cm2 being resurfaced with this method. Most reports describe burring of the outer table as a preliminary step which can lead to complications such as full-thickness bone loss, excessive bleeding, dural injury/exposure, and weakening of the cranial vault. The purpose of this study is to report the successful use of Integra in full-thickness scalp wounds devoid of pericranium through direct application on cortical bone without preliminary burring of the outer cortex.
Methods: A series of four consecutive full thickness scalp wounds devoid of pericranium were treated with direct application of Integra on intact cortex. The size of the avascular segments ranged from 25 cm2 to 120 cm2. After a period of 3-4 weeks, split thickness skin grafting was performed. Follow up ranged from 3-6 months following skin grafting.
Results: The percent take of subsequent skin grafting was excellent, ranging from 85% to 100%. In one case, partial failure of skin grafting with Integra was later determined to be due to undiagnosed underlying osteomyelitis. Regardless of wound etiology, punctate bleeding was predictive of successful Integra and subsequent skin grafting.
Conclusions: Integra can be used directly on cortical bone without preliminary burring of the outer table provided punctate bleeding from the cortical bone is observed. This may avoid the potential morbidity of thinning the calvarial bone while preserving this step as a backup option.
