Can Integra outperform local flaps in the reconstruction of face and scalp skin cancer defects?

Introduction: Skin cancer of the head is the commonest cancer worldwide, frequently affecting older, medically complex patients, rendering postresection reconstruction challenging.

Methods: This is a retrospective cohort study comparing the clinical outcomes of oncologic soft tissue defect reconstruction of the head with the Integra dermal regeneration template versus local flaps. Defects reconstructed at a single center between January 1, 2022, and December 31, 2022, were included. Multivariable logistic regression determined the independent effect of demographics and surgical factors on the odds of complications.

Results: A total of 125 defects were included, 59 reconstructed with Integra and 66 with a local flap. Baseline characteristics were similar, but patients were significantly older within the Integra group (84 vs. 78 years, P = 0.022) with larger defect sizes (699 mm² vs. 454 mm², P < 0.001). Multivariable analysis showed that when accounting for confounding variables, local flap reconstruction remains associated with significantly reduced odds of complications (OR 3.54 [1.59-8.25], P = 0.002). The commonest complication was graft failure, with all cases recorded in the Integra group. Graft failure did not correlate with clinical failure, as 90% of Integra wounds were fully healed at six months.

Conclusion: Reconstruction of oncologic soft tissue defects with Integra is related to high graft failure rates, limiting its clinical effectiveness compared to local flaps. Surgical factors like subsequent epidermal grafting, fenestration, or antibiotic prophylaxis are likely to improve outcomes. The development of a standardized surgical approach based on randomized, prospective research is warranted, as Integra can enable the closure of large defects in medically complex patients, unsuitable for reconstruction by other methods.