Abstract

Background: Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous sarcoma that infrequently involves the scalp but often requires wide resection due to its infiltrative growth pattern. Resulting defects may expose calvarium and pose reconstructive challenges because of limited scalp mobility and aesthetic considerations. While split-thickness skin grafts (STSG) and flap reconstruction are commonly used, dermal substitutes have only rarely been described in scalp DFSP reconstruction and are typically used as staged adjuncts prior to grafting. Methods: We present a case series of three patients with scalp DFSP who underwent reconstruction using dermal regeneration templates, including Integra® and NovoSorb® biodegradable temporizing matrix (BTM). Clinical outcomes, reconstructive course, and aesthetic results were evaluated. Results: The first patient underwent Integra placement over exposed calvarium followed by delayed STSG, achieving complete epithelialization. The second patient underwent staged reconstruction following Mohs surgery, including Integra placement with STSG and subsequent revision using BTM to improve contour and color match of the forehead and hairline. The third patient underwent BTM placement over a large occipital scalp defect and achieved complete epithelialization by secondary intention without the need for skin grafting. Across cases, dermal substitutes provided stable wound coverage and facilitated reconstruction in challenging defects with exposed bone. Conclusions: Dermal substitutes represent versatile tools for reconstruction of complex scalp defects following DFSP excision. Integra may be advantageous in large defects with significant calvarial exposure, while BTM can facilitate wound closure with favorable color match and may allow healing without skin grafting in selected cases. These findings highlight dermal substitutes as valuable alternatives within the reconstructive armamentarium for scalp DFSP.

Keywords

dermatofibrosarcoma protuberans (DFSP), scalp reconstruction, dermal regeneration template, Integra, NovoSorb BTM, Mohs micrographic surgery