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Integra in Scalp Reconstruction After Tumor Excision

Recommendations From a Multidisciplinary Advisory Board

Magnoni, Cristina MD, PhD*; De Santis, Giorgio MD; Fraccalvieri, Marco MD; Bellini, Pietrantonio MD§; Portincasa, Aurelio MD||; Giacomelli, Luca PhD; Papa, Giovanni MD#

doi: 10.1097/SCS.0000000000005717
Clinical Studies

Integra is a dermal regeneration template used in the reconstruction of burns, traumatic injuries, or excision lesions in patients who present particular risk factors for traditional surgical procedures. A multidisciplinary advisory board of expert dermatologists and plastic surgeons have discussed the use of Integra in the reconstruction of scalp defects after tumor excision, focusing on the evidence derived from literature and on their experience in the treatment of approximately 400 patients. In this position paper, the authors summarize the main evidence discussed during the board, and the common practice guidelines proposed by the experts. The use of Integra is recommended in elderly patients with multiple comorbidities who have a higher risk for potential complications in traditional surgery; these patients may in fact benefit from a lower anesthetic risk, a less complicated postsurgical care and limited morbidity at the donor site obtained with the dermal template. Integra should also be used in the reconstruction of large and complex wounds and in case of bone exposure, as it helps to overcome the challenges related to wound healing in difficult areas. Notably, Integra has proven to be effective in patients who have undergone previous surgical procedures or adjuvant radiation therapy, in which previous incisions, scarring and radiation damages may hamper the effectiveness of traditional procedures. Finally, Integra is recommended in patients with recurrent and aggressive tumors who need closer tumor surveillance, as it gives easy access to the tumor site for oncologic follow-up examination.

*Department of Dermatology, University of Modena and Reggio Emilia, Modena

Plastic Surgery Unit, Polyclinic of Modena

Plastic Surgery Department, Azienda Ospedaliero Universitaria della Città della Salute e della Scienza of Turin, Turin

§Department of Surgery, Medicine, Dentistry and Morphological Sciences With Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Unit of Dentistry and Oral-Maxillo-Facial Surgery, Modena

||FEBOPRAS Department of Plastic and Reconstructive Surgery, University of Foggia Medical School, Foggia

Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa

#Plastic Surgery, University of Trieste, Trieste, Italy.

Address correspondence and reprint requests to Cristina Magnoni, MD, PhD, Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy; E-mail:

Received 28 March, 2019

Accepted 20 April, 2019

AP received personal fees from Integra LifeScience. Editorial assistance was provided by Ambra Corti, and Aashni Shah (Polistudium srl) funded by internal funds. The remaining authors report no conflicts of interest.

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© 2019 by Mutaz B. Habal, MD.