Scalp reconstruction after oncologic resection: A retrospective comparative study of acellular dermal matrices and local flap

Scalp reconstruction following oncologic resection presents significant challenges due to limited tissue mobility, functional requirements, and aesthetic considerations. Traditional approaches include local flaps, which provide vascularized, durable coverage but may involve longer operative times and donor site morbidity. Acellular dermal matrices (ADM) offer a staged, less invasive alternative, potentially suitable for patients with limited donor options or reduced surgical tolerance. This study compares ADM and local flaps in terms of healing, complications, and aesthetic outcomes, with the aim of identifying clinical contexts in which each technique may be preferred. This retrospective case-control study included 45 patients undergoing scalp reconstruction after wide local excision of skin tumors. Patients were divided into two groups: ADM-based reconstruction and local flap-based reconstruction. Primary outcomes included wound healing time, complication rates, and aesthetic results (Vancouver Scar Scale and Patient Satisfaction Scores). Secondary outcomes included operative time, hospital stay, and need for secondary procedures. Statistical comparisons used t-tests and Fisher’s exact test (p < 0.05). Flap reconstruction resulted in faster wound healing (23 ± 4 days vs. 72 ± 8 days; p < 0.05) and shorter total operative time (59 ± 5 vs. 77 ± 7.6 minutes; p < 0.05), although ADM allowed for shorter first-stage procedures. ADM was associated with a higher rate of localized infection (19%), while flaps more frequently showed partial necrosis (16%). Aesthetic outcomes and patient satisfaction were comparable. Complication rates did not differ significantly by age. Hair loss did not affect satisfaction in the ADM group, which included mainly older patients. Both ADM and local flaps are effective reconstructive options, each with distinct advantages. ADM may be preferable in frail patients or when donor site availability is limited, while flaps remain the standard for large or high-tension defects. Rather than competing, these techniques should be viewed as complementary tools within a patient-specific reconstructive strategy. Further studies are warranted to refine selection criteria and explore hybrid approaches.