Can a Single-Stage Approach Using a Dermal Regeneration Template Lead to Satisfactory Scalp Defect Reconstruction After Skin Cancer Excision?

BACKGROUND: Large-defect reconstructive surgeries for skin cancer can be performed using different approaches. Integra Dermal Regeneration Template (DRT, Integra Life Sciences, Princeton, New Jersey, the United States) is a membrane utilized to fill skin defects, followed by second-stage surgery with a full-thickness skin graft or flap. PURPOSE: To evaluate the frequency of success of the single-stage scalp reconstructive surgeries using the DRT membrane without second-stage surgery and its feasibility in practice. STUDY DESIGN, SETTING, AND SAMPLE: This retrospective case series study was conducted to investigate the outcomes of patients with skin cancer scalp defects, reconstructed using DRT, from June 2019 to June 2022, in the Oral and Maxillofacial Department at Ashford and St. Peter's Hospitals, United Kingdom. The patients who underwent further surgery were excluded. PREDICTOR VARIABLE: Not applicable. MAIN OUTCOME: This study aimed to evaluate the achievement of complete re-epithelialization solely using the DRT membrane along with appropriate dressing management, scored as a "yes" or "no." COVARIATES: Patient's age, defect size, timing of bolster, DRT silicone layer, and dressing removal; anticoagulation, antibiotics, complications, and appointments until complete healing. ANALYSES: Descriptive statistics were computed for each variable. RESULTS: Forty patients were included in this study and 90% re-epithelialized without complications. Two cases of infection and three bleeding events were recorded. The mean patients' age was 81.5 ± 7.7 years, and the average defect size was 14.7 ± 10 cm2. The bolster and silicone layers were removed at 9.1 ± 3.2 and 29.2 ± 12.9 days, respectively. The average number of appointments until healing was 7.8 ± 4.8. Healing time was 3.8 ± 2.1 months, frequency of failure was 10, and 40% received antibiotics. CONCLUSIONS: In our experience, the DRT membrane can be used as a successful single-stage approach in minimizing the need for further surgery. Further studies are needed.

Surgical Removal of a Canine Displaced in the Floor of the Nasal Cavity: Case Report and Review of the Literature.

34 year old patient referred to ENT for left sided nasal blood-stained discharge and blocked nasal passage. Radiographic investigation confirmed the presence of an ectopic canine near the nasal cavity. Surgical removal of the ectopic canine is done through an intra-oral maxillary approach. The objective of this case report is to present the detailed surgical management.