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A Prelude to Simplified Calvarial Reconstruction: Coverage of Bare Skull with Gamma-graft Promotes Granulation and Facilitates Skin Grafting
Sivak WN, Bourne DA, Miller MP, and Manders EK
University of Pittsburgh
2015-03-14
Presenter: Sivak WN
Affidavit:
This abstract is the original work of Dr Sivak.
Director Name: Joseph Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
INTRODUCTION: Repair of scalp defects with exposed calvaria remains a difficult clinical problem. Herein, we present a simple alternative method of scalp reconstruction. Coverage of bare skull with GammaGraft® (Promethean LifeSciences, Inc.) allows for the evolution of granulation tissue and permits subsequent skin grafting without need for burring, drilling or other manipulation of the outer table of the calvaria.
METHODS: A retrospective review of patients undergoing scalp reconstruction utilizing GammaGraft® and subsequent skin grafting was performed at our institution.
RESULTS: From our cohort, 5 patients treated with GammaGraft® and subsequent skin grafting had both immediate and long-term follow up available. Indications for scalp reconstruction included erosions of prior skin grafts and direct excision of full thickness scalp and pericranium. Average time to definitive skin grafting was 3 weeks; repeat application of GammaGraft® was required in some cases with reapplication to subsequent smaller wounds as healing occurred. Complications were minor and consisted of ongoing wound drainage. Alternative flap reconstruction was not required in any patient due to treatment failures. No major complications, wound infections or early reoperations occurred in any of the patients; one patient to date has required repeat reconstruction due to recurrent disease.
CONCLUSIONS: Coverage of bare skull with GammaGraft® and subsequent skin grafting provides a simple and elegant solution to an often too difficult clinical problem. Confirmed by excellent results, the utilization of GammaGraft® in calvarial reconstruction represents a paradigm shift in surgical care of complex scalp defects with exposed bone.
