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Staged Surgical Management with Biological Matrix for Treatment of Dissecting Cellulitis of the Scalp
Justin Puthoff MD, Kelly Spiller MD, Anniki Witter MD, Ryan Gobble MD
University of Cincinnati
2025-01-10
Presenter: Justin Puthoff, MD
Affidavit:
I certify that the submitted material represents original work of the above named medical students, residents, and/or attending physician. This work has not yet been published in any journal and has not been presented at any major meetings.
Director Name: Ann Schwentker, MD
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Dissecting Cellulitis of the Scalp (DCS) is one of the described follicular occlusive disorders that presents unique reconstruction challenges after surgical excision of medically refractory disease. Large and near total defects often require a combination of techniques beyond local tissue rearrangement, such as tissue expansion or flap reconstruction to achieve "replacing like with like tissue" and addressing the aesthetic considerations of hair bearing skin.
Methods: We report a single case study involving a 43 year old male with lifelong DCS, having exhausted multiple medical and minimally invasive strategies including, antibiotics, immunomodulators, corticosteroid injections, lasers, and other minor debridement. We opted for radical scalpectomy with excision to the level of the periosteum and superficial musculature of the posterior neck with intervening cod-based skin graft in sheet and powder form for granulation tissue regeneration. Four weeks later, we achieved a staged reconstruction with 1:1.5 meshed split thickness skin graft.
Results: At 8 month follow up, patient has excellent aesthetic outcome without contour irregularities or any evidence of local recurrence. Patient remains off all medication for his DCS. He is still pending 1 year follow up.
Conclusions: This case highlights the use of multi-medium cod-based grafts for granulation tissue regeneration before split thickness skin grafting in achieving a contour-free aesthetic outcome in large and near total defects.
