Bilayer Wound Matrix-Based Cutaneous Scalp Reconstruction: A Multidisciplinary Case Control Analysis of Factors Associated with Reconstructive Success and Failure

Abstract Background Scalp wounds pose reconstructive challenges due to lack of skin elasticity, potential for compromised adjacent tissue, and desire for restoration of aesthetic contour. Bilayer Wound Matrix (BWM) has been successfully employed as a treatment modality for complex, full-thickness wounds of the scalp. We aimed to highlight risk factors for BWM success and failure in complex wounds of the scalp. Methods A retrospective case-control study was performed from 2012 - 2019 of adult subjects presenting to plastic or dermatologic surgery with complex scalp defects with or without exposed calvarium who underwent staged reconstruction with BWM and split-thickness skin grafting or secondary intention. Success was defined as complete wound re-epithelialization within 90-day follow-up without additional operative procedures for wound coverage. Demographics, comorbidities, treatment history, wound characteristics, and clinical course were analyzed and correlated with reconstructive outcomes. Results In total, 127 subjects were identified for inclusion, with mean age 74.6 ± 12.2 years, defect area 80.2 ± 89.4 cm2, and wound age 10.0 ± 65.4 days, respectively. Successful wound reconstruction occurred in 107 (84%) subjects. Postoperative wound infections were an independent predictor of BWM failure at 90-days (Odds Ratio: 6.4; 95% Confidence Interval: 1.5 – 26.7, p Conclusion : BWM represents a reliable and efficacious modality in the treatment of complex scalp wounds. Patient comorbidities may not heavily influence the success of BWM in establishing adequate wound coverage, however, preoperative radiation and postoperative wound infection may often lead to reconstructive failure.