Abstract
Background
Reconstruction of scalp defects after oncologic resection remains challenging because of limited tissue mobility and frequent periosteal involvement. In elderly or frail patients, complex procedures such as large local flaps or free tissue transfer carry significant morbidity. Acellular dermal matrices (ADMs) offer an alternative for single-stage wound coverage. This multicentre study compared a tissue bank-manufactured human ADM with the commercial dermal regeneration template Integra®.Methods
A multicentre observational study was conducted between January 2023 and June 2025 at two university hospitals. Sixteen patients underwent scalp reconstruction after excision of nonmelanoma skin cancer: six received cadaveric human ADM and ten Integra®. The primary outcome was time to complete epithelialization. Secondary outcomes included graft integration, postoperative complications, operative time, and material cost.Results
All grafts integrated successfully, with no failures. Mean healing time was shorter with ADM (1.8 ± 0.3 months) than with Integra® (3.5 ± 1.4 months; mean difference 1.7 months, 95% CI 0.48-2.92; p = 0.01; Cohen's d = 1.54). One postoperative infection occurred in the ADM group and resolved with oral antibiotics; none occurred with Integra®. Operative times were comparable. Material cost was approximately 72% lower with tissue bank-derived ADM (€500 vs. €1,759 per reconstruction).Conclusions
In this multicentre pilot study, single-stage scalp reconstruction using tissue bank-manufactured human ADM achieved successful graft integration, faster healing, and substantially lower material cost than Integra®. Given the small sample size (n = 16) and observational design, these findings should be considered preliminary and hypothesis-generating.