The role of free tissue transfer in reconstruction of full thickness scalp defects

Aim: Describe our institutional experience with different forms of reconstruction, including free tissue transfer vs. other newer techniques such as Integra, an artificial dermis composed of bovine collagen lattice with a layer of an artificial synthetic silicon epidermis.Methods: We performed a retrospective review of patients who underwent full-thickness scalp reconstruction at a single tertiary care institution between January 2016 and March 2021. Patient demographic information, co-morbidities, defect depth and size, reconstruction type, American Society of Anesthesiologists (ASA) score, and postoperative complications were collected.Results: Of the total 32 patients collected, 68.7% were male and 31.2% were female with an average age of 57.88 years (range 3-91 years). Malignancy (n = 26, 81.2%) was the most common reason for scalp reconstruction, followed by trauma (n = 5, 12.5%) and non-healing wound/exposed hardware (n = 2, 6.2%). The majority of patients underwent reconstruction with Integra +/- split thickness skin graft (n = 15, 46.8%) followed by tissue expander in combination with local flap (n = 6, 18.7%) and microvascular reconstruction (n = 5, 15.6%). Patients who underwent reconstruction with Integra had more medical comorbidities and a higher ASA score (2.93 ± 0.25) than those who underwent free tissue transfer (2.75 ± 0.96). Large defects (> 6.1 cm) were mostly reconstructed via the Integra/Integra + STSG method (n = 13, 59.1%), and all immunosuppressed patients were reconstructed with Integra (n = 3, 100%). Scalp defects with exposed dura were all reconstructed with free tissue transfer (n = 3, 100%). Four Integra-reconstructed patients required revision surgery due to partial graft failure.Conclusion: Free tissue transfer is widely used to reconstruct large and full-thickness scalp defects. However, Integra can be a viable option in patients with numerous medical comorbidities or extensive scalp defects requiring complex reconstruction