Staged reconstruction of an extensive oncologic scalp defect using two complementary dermal scaffolds and a cultured autologous skin equivalent: A case report - 09/09/26

Doi : 10.1016/j.jormas.2026.102973

Luis Junquera ^a,^⁎ , Sergi Herrera i Nogués ^b, Ana Martínez-Carrillo ^b, Nikita Deinega ^b, Sara Llames ^c,^d,^e,^f, Marta Pevida ^c,^g,^d,^e, Luis García-Consuegra ^b, Álvaro Meana ^c,^g,^d,^e

^a Department of Surgery and Medical-Surgical Specialties, University of Oviedo, Julián Clavería 6, 33006 Oviedo, Spain

^b Department of Oral and Maxillofacial Surgery, Central University Hospital of Asturias, Avenida de Roma s/n, 33011 Oviedo, Spain

^c Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, University of Oviedo, Oviedo, Spain

^d Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain

^e Tissue Engineering Unit, Centro Comunitario de Sangre y Tejidos de Asturias, Oviedo, Spain

^f Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain

^g Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain

^⁎ Corresponding author at: Department of Surgery and Medical-Surgical Specialties, University of Oviedo, Julián Clavería 6, 33006 Oviedo, Spain. Department of Surgery and Medical-Surgical Specialties University of Oviedo Julián Clavería 6 Oviedo 33006 Spain

Highlights

•	Two complementary dermal scaffolds prepared a 16 × 13 cm wound bed.
•	A cultured autologous skin equivalent achieved stable 9-month coverage.
•	Staged reconstruction avoided flap surgery in a frail elderly patient.
•	Culture-directed antibiotics resolved a localised wound infection.

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Abstract

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.

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Keywords : Acellular dermis, Basal cell carcinoma, Scalp, Artificial skin, Tissue engineering