The Adjunctive Applications of Integra® in Free-Flap Surgery to the Scalp: A Two-Case Experience

James C Yuen,1 Elizabeth N Dawson,2 Connor S Miller,3 Madalyn H Bowman,2 Aimee A Tran2 1Division of Plastic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA; 2College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA; 3University of Kansas Medical Center, Department of Plastic, Burn and Wound Surgery, Kansas City, Kansas, USACorrespondence: James C Yuen, Chief, Division of Plastic Surgery University of Arkansas for Medical Sciences, 4301 West Markham, Slot 720, Little Rock, Arkansas, 72205, USA, Tel +1 501-686-8711, Email [email protected]: Free flaps for scalp reconstruction occasionally traverse the face to reach the recipient vessels in the neck if the superficial temporal vessels are unavailable and vein grafts are circumvented. When using the latissimus flap, the facial skin at the exposure incision is not redundant enough to cover the proximal flap. Integra® (Integra LifeScience) can be applied to cover the exposed portion of the flap containing the vascular pedicle, expediting completion of the operation without the need to perform immediate skin grafting. If flap perfusion is marginal, the surgeon is relieved of the concern for autologous skin graft loss if flap perfusion worsens. After flap perfusion is secured, a skin graft is applied over the neodermis regenerated by Integra. We describe two cases utilizing Integra as an adjunctive skin substitute for coverage of the exposed portion of the flap containing the pedicle, thus obviating the need for immediate skin grafting.Keywords: adjunct, free flap, integra, scalp, reconstruction, vertex