Case report: Reconstruction exposed bone following excision of malignant scalp tumors, multidisciplinary approach of an old method with new materials

Basal cell carcinoma and squamous cell carcinoma are malignant epithelial tumors that frequently occur on the scalp. The reconstruction of large surgical breaches in which the scalp was removed leaving the bone bare has always been a difficult problem to solve. An 84-year-old patient in good general condition with an extensive surgical breach in the scalp comes to our observation where a sessile squamous cell carcinoma was removed 2 months ago in another hospital; The surgeon had removed the aponeurotic galea with bone exposure. There are numerous surgical solutions proposed: reconstruction by a secondary intention, grafts of dermal matrix, transposition flaps and finally an old technique that involves the perforation of the cranial theca. Dermal matrices cannot be used on bone as they still need blood support to facilitate the repair process. Local flaps could not be used as the skin was seriously photodamaged and treatment of this would further delay the repair. In our case the solutions adopted with other patients were not applicable, therefore we evaluated the literature to determine which solution could be adopted. We had experience with tissue perforation in large ulcers and position punch grafting to facilitate re-epithelialization therefore we also drew inspiration from this method. The technique adopted allowed an immediate reconstruction limiting the discomfort to the patient with few dressings and complete healing in about 1 month. Scalp, the graft is completely rooted in 3 month. •Large surgical breaches in the scalp removed leaving the bone bare have been a problem to solve.•Dermal matrices facilitate the engraftment of full-thickness grafts.•It is important that surgical procedures limit patient discomfort in the weeks following surgery.