Acellularized cadaver dermis for reconstruction of complex scalp defects

Large scalp defects with exposed calvarium secondary to oncologic resections or trauma pose a challenging problem for the reconstructive surgeon. There exist many surgical techniques ^,  for various defect locations, sizes and depths as well as considerations for patient general health and desires; however, each is limited and can result in inferior cosmetic outcomes and patient distress. Wound healing by secondary intention poorly addresses deep defects and risks calvarium desiccation and infection despite meticulous wound care. Primary closure becomes impractical for defects larger than 3 cm in diameter. Local advancement flaps are constrained by the thick galeal aponeurosis of scalp tissue. Unfortunately, skin grafts placed directly over bleeding burred cortex, diploe or even intact pericranium often contract and—given the lack of sufficient thickness, supporting dermal tissue, and wound bed vascularization, or prior radiation —may break down and ulcerate despite minimal trauma. Tissue expansion requires multiple fillings, can be socially difficult, and come with infection and extrusion risks. Increased length of surgery, greater post-operative complications, and donor-site morbidity makes free flap tissue transfers a less practical option for elderly or poor general health patients; furthermore flap use can limit future surgical options in cases of positive surgical margins on final pathology or recurrence.