Integra Versus BTM for Scalp Reconstruction Following Mohs Micrographic Surgery: A Comparative Outcomes Analysis

Scalp defects following Mohs micrographic surgery (MMS) for cutaneous malignancy present a significant reconstructive challenge, particularly in the setting of exposed calvarium or prior radiation. Integra Dermal Regeneration Template and NovoSorb Biodegradable Temporizing Matrix (BTM) are acellular dermal substitutes increasingly used for scalp reconstruction, yet no study has directly compared their outcomes in this context. A retrospective review was conducted of 49 patients who underwent scalp reconstruction with Integra (n=21) or BTM (n=28) following MMS at a single academic institution between January 2022 and October 2025. Primary outcomes included time to re-epithelialization, time to definitive coverage, complication rates, and need for secondary procedures. Multivariable regression was used to identify independent predictors of outcomes. The mean patient age was 73.9±13.2 years. The average defect size was 31.6±21.8 cm 2 , and 71.4% of patients had exposed bone. Time to re-epithelialization (45.6±18.9 d for BTM versus 48.3±19.6 d for Integra, P =0.63) and overall complication rates (17.9% versus 19.0%, P =1.00) were comparable between groups. BTM patients required secondary split-thickness skin grafting significantly less often than Integra patients (3.6% versus 33.3%, P =0.01), and this difference persisted on multivariable analysis (OR=24.31, P =0.03). Prior radiation was the strongest independent predictor of complications (OR=22.48, P =0.04). Both matrices yield equivalent healing and complication outcomes. BTM is associated with significantly fewer secondary skin grafting procedures and offers practical advantages, including lower cost and no requirement for bolster dressing.