Division of Plastic Surgery, Department of Surgery, Cooper University Hospital, Camden, NJ, US.
J Wound Care. 2023 Apr 2;32(4):206-212. doi: 10.12968/jowc.2023.32.4.206.
The armamentarium of options available for soft tissue reconstruction of the scalp spans the reconstructive ladder. The purpose of this paper is to describe a case series of patients with exposed cranium and dura who were successfully reconstructed using esterified hyalomatrix (eHAM, Hyalomatrix, Medline Industries Inc., US).
After obtaining Institutional Review Board approval, a retrospective review of the senior author's (ALF) patient database was completed. Patients who underwent scalp reconstruction using eHAM were identified. Each patient's chart was reviewed and data collected on demographics, days to skin graft, duration of follow-up, pathology, comorbidities and complications.
This case series consisted of five patients aged ≥18 years, with scalp wounds exposing dura or cranium, who were treated with eHAM as a bridge to definitive coverage with a skin graft. Each wound successfully granulated the exposed critical structure with the use of the eHAM. The mean time to skin graft coverage was 41 days, with a range of 13-79 days. Of the series of five patients, four had a follow-up of ≥12 weeks. The mean defect size was 90.2cm.
Complex scalp reconstruction can be accomplished using healing by secondary intention, skin grafts, local flaps, tissue expansion and free tissue transfer. As shown in this case series, another option available in select patients is using a dermal substitute such as eHAM. This is one treatment option available to reconstructive surgeons in multiple specialties.
头皮软组织重建可供选择的方法范围广泛，跨越了重建阶梯。本文旨在描述一组使用酯化透明质酸基质（eHAM，Hyalomatrix，Medline Industries Inc.，美国）成功重建暴露颅骨和硬脑膜的患者的病例系列。
在获得机构审查委员会批准后，对高级作者（ALF）的患者数据库进行了回顾性审查。确定了使用 eHAM 进行头皮重建的患者。回顾每位患者的病历，并收集人口统计学、植皮天数、随访时间、病理、合并症和并发症等数据。
本病例系列包括五名年龄≥18 岁的患者，头皮伤口暴露硬脑膜或颅骨，使用 eHAM 作为桥接，最终用皮肤移植物进行确定性覆盖。每个伤口均成功地使用 eHAM 使暴露的关键结构肉芽化。皮肤移植物覆盖的平均时间为 41 天，范围为 13-79 天。在五名患者的系列中，有四名患者的随访时间≥12 周。平均缺损大小为 90.2cm。
复杂的头皮重建可以通过二期愈合、植皮、局部皮瓣、组织扩张和游离组织转移来完成。如本病例系列所示，在某些患者中，另一种选择是使用真皮替代物，如 eHAM。这是多个专业的重建外科医生可用的一种治疗选择。
