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Closure of a Complex Traumatic Scalp Wound with 7 Consecutive Layers of ýDermal Regeneration Template
Shaher Khan, MD ý
Bryan Armijo, MD
Bardia Amirlak, MD
Devra Becker, MD
University Hospitals/ Case Medical Center
2010-03-03
Presenter: Shaher Khan
Affidavit:
Director Name:
Author Category: Resident/Fellow
Presentation Category: Clinical
Abstract Category: General Reconstruction
A 59 year old male with a traumatic scalp wound infection presented after initial management at another hospital with a 3x8 cm eschar on the superior aspect. Methods: A planned staged reconstruction was undertaken that initially included galeal scoring of the wound. Two periosteal flaps were then used for coverage of bone along with 8 local rotation flaps for partial closure. After 1 week, the patient was taken back to the OR where debridement of the scalp wound with burring of outer table was carried out along with placement of the dermal regeneration template (DRT) in six layers stacked in a consecutive fashion by folding it over on itself. This reconstruction was then ultimately covered by placement of a fenestrated bilayer DRT. Results: The patient was followed closely in clinic on a weekly schedule where the Integra was noted to be in place, pink on the periphery, and with the silicone well adhered. After 7 weeks, the silicone started to separate from the Integra with complete separation observed by week 8. Upon removal of the silicone, red granulation tissue with punctate bleeding was noted and the Integra appeared to have taken well on to the wound bed. On week 11 a split-thickness skin graft was successfully applied. Conclusion: This case presents a unique application of DRT with 7 layers placed simultaneously in the reconstruction of a full-thickness traumatic scalp wound with exposed bone. This soft-tissue construct offers another viable option for the treatment of complex scalp wounds following extensive resection.
