Luqman A. Majid a, Vyan H. Mohammed Raouf a, Shakhawan S. Zorab a, and Mohammed S. Raheem a

a Sulaimani Burn and Plastic surgery Hospital, Sulaimani, Kurdistan Region, Iraq. 

Submitted: 31/5/2021; Accepted: 11/11/2021; Published: 21/3/2022

DOI Link: https://doi.org/10.17656/jsmc.10347 



Reconstruction of lacerating scalp wound after a Road Traffic accident (RTA) with a sizeable full-thickness defect can pose a challenge for the surgeon. Various options are available for scalp wound reconstruction, including skin grafts and flaps but when the defect reaches the pericranium, the options become very limited

Case presentation 

We present the case with a sizeable full-thickness scalp defect and cranial bone abrasions after RTA. Our management plan was to cover the bone with a dermal regeneration matrix (INTEGRA). However, the challenge was the absence of the pericranium, which we overcame by using an electrical saw to abrade the bed and directly apply the (INTEGRA). It was taken very well in 19 days. The newly formed dermis was covered with a meshed split-thickness skin graft.


We found that the combination of abrading a thin layer of an exposed skull bone after trauma with pericranial loss, direct application of dermal regeneration template (INTEGRA) and skin graft are safe and effective in managing large traumatic full-thickness scalp wounds with bare bone.


After four months follow up the good results of this case present a practical time-expedient operative approach to overcome the challenges faced by surgeons in dealing with sizeable traumatic scalp wounds that leave behind the unhealthy bare bone. 



INTEGRA, Scalp, Pericranium.


1. Shaun C. Desai, MD1; Jordan P. Sand, MD1; Jeffrey D. Sharon M et al. Scalp Reconstruction An Algorithmic Approach and Systematic Review. JAMA Facial Plast Surg. 2015;17:3–69. 

2. Yana Puckett,MD. Management of skin defect following resection of Stage IV scalp melanoma: A case report. Int J Surg Case Reports Vol 29, 2016, Pages 8-10

3. AnessaWatts DMD. Reconstruction of Complex Full-Thickness Scalp Defects After Dog-Bite Injuries Using Dermal Regeneration Template (Integra): Case Report and Literature Review. J Oral Maxillofac Surg. 2018;77(2):338–51. 

4. SteinerA.HubertusA. Scalp reconstruction: A 10-year retrospective study. J Cranio-Maxillofacial Surg. 2017;45(2):319–24. 

5.  Khan, Muhammad A. A. Ali, Syed N . Use of Dermal Regeneration Template (Integra) for Reconstruction of Full-Thickness Complex Oncologic Scalp Defects. J Craniofacial Surg May 2010 - Vol 21 - Issue 3 - p 905-909

6. Barbara De Angelis. One-Stage Reconstruction of Scalp after Full-Thickness Oncologic Defects Using a Dermal Regeneration Template (Integra)  biomed research international. 2015. p. 11.

7. Moiemen, Naiem S. ; Vlachou, Evangelia MRCS;  Reconstructive Surgery with Integra Dermal Regeneration Template: Histologic Study, Clinical Evaluation, and Current Practice. Plast Reconstr Surg. 2006;117(7S):160S-174S.

8. Cemil Dalay, Erol Kesiktas, MetinYavuz Gokhan, Ozerdem Sabri Acarturk. Coverage of scalp defects following contact electrical burns to the head: A clinical series. 2006;32(2):201–7. 0.

Full Text

 © The Authors, published by University of Sulaimani, College of Medicine

This work is licensed under a Creative Commons Attribution 4.0 International License.