Staged reconstruction of an extensive oncologic scalp defect using two complementary dermal scaffolds and a cultured autologous skin equivalent: a case report

Reconstruction of extensive oncologic scalp defects is challenging in older patients who are poor candidates for flap surgery. We report an 87-year-old woman who underwent wide excision of a 14 × 11 cm basal cell carcinoma, resulting in a 16 × 13 cm full-thickness scalp defect with partial calvarial exposure. The anterior wound was covered with a human acellular dermal matrix and the posterior wound with a bilayer collagen-glycosaminoglycan dermal regeneration template. After formation of a vascularised neodermis, the defect was resurfaced with a cultured autologous skin equivalent; a second application treated residual uncovered areas. Both scaffolds integrated. A localised Enterobacter cloacae infection resolved with susceptibility-guided oral levofloxacin. Progressive epithelialisation achieved complete, durable coverage with an acceptable contour and no further complications at 9 months. This staged strategy avoided flap surgery and extensive donor-site morbidity.