Abstract

Scalp defects following Mohs micrographic surgery pose reconstructive challenges due to limited adjacent tissue mobility and the frequent presence of exposed calvarium. Dermal substitutes such as Integra® Dermal Regeneration Template and NovoSorb® Biodegradable Temporizing Matrix (BTM) have broadened reconstructive options by enabling reliable neodermis formation over both vascularized soft tissue and carefully prepared bone. Although both matrices are well documented in the literature, direct comparisons specific to scalp reconstruction are lacking. We present two cases illustrating differences in clinical course, healing time, and reconstructive advantages between Integra and BTM in scalp defects of varying size and depth. The first case involved a large (63 cm²) occipitoparietal defect with extensive bone exposure in an actively smoking 49-year-old man. Integra achieved successful integration and definitive coverage after staged split-thickness skin grafting, with complete healing by postoperative day 103. The second case involved a smaller (11.9 cm²) parietal defect with a limited area of exposed bone in a 78-year-old man with multiple comorbidities. BTM integrated uneventfully and epithelialized without the need for grafting, achieving full healing by day 74. These cases demonstrate that Integra remains advantageous for large defects with substantial calvarial exposure, while BTM offers a cost-effective, fully synthetic alternative that performs well in smaller wounds with preserved vascularity. Individualized defect assessment—including size, vascularity, comorbidities, and degree of bone exposure—remains critical in selecting the optimal matrix for scalp reconstruction. Further comparative studies with larger cohorts are warranted.

Keywords

scalp reconstruction, Mohs micrographic surgery, integra, biodegradable temporizing matrix, dermal substitute, exposed calvarium, neodermis formation, split- thickness skin graft