Abstract 24: Comparison of full-thickness versus split-thickness skin graft reconstruction of scalp defects
Authors: Zhao Xue , Mclean Scott 
Published: December 2017

Abstract
Objective: To compare the surgical outcomes of patients who underwent full-thickness skin grafts (FTSG) versus split-thickness skin grafts (STSG) for the reconstruction of scalp defects.
Background: A wide range of scalp defects may arise following oncologic resection of scalp malignancies and the reconstruction of such defects may be challenging for reconstructive surgeons. In larger surgical defects, skin grafts may be used to facilitate wound healing and decrease the complexity of wound care, especially when a lack of hair-bearing scalp is not a concern. The majority of literature on scalp reconstruction only describes the use of STSG and generally recommends it only on a well-vascularized wound bed with intact periosteum. There is also a general belief that FTSG have lower survival compared with STSG, although there are limited published data on the use of FTSG for scalp reconstruction or any data comparing the outcomes of these two methods in scalp reconstruction. This study seeks to provide the first objective comparison of surgical outcomes in FTSG versus STSG for the reconstruction of scalp defects.
Methods: We performed a retrospective chart review of patients who underwent scalp reconstruction with skin grafts at a single-institution academic tertiary care center from 2011 and 2016. χ2 or Fisher exact tests were used to compare graft take and complication rates. The effects of graft type, defect type, graft size, and patient comorbidities on the likelihood of graft take and complications were analyzed using multivariate logistic regression.
Results: 125 full-thickness and 93 split-thickness skin grafts were performed on 200 patients with scalp defects. FTSG required fewer average reconstructions compared with STSG (1.06 vs. 1.24, P = 0.002). 92.8% of FTSG had complete graft take compared to 78.5% of STSG (P = 0.002). This difference between complete graft take was more evident in defects with exposed calvarium (87.2% vs. 47.6%, P = &lt;0.001). Despite higher rates of minor debridement, FTSG resulted in less postoperative bone exposure and wound breakdown compared to STSG on both intact pericranium and exposed calvarium defects. Preoperative radiation, immunosuppression and increased graft sizes were also significant predictors of graft outcomes.
Conclusion: Skin grafts, especially full-thickness, provide a versatile, reliable and simple approach for reconstructing medium to large scalp defects in the appropriate patient. Even on defects with bare calvarium, FTSG can have excellent graft take when a vascularized recipient bed is prepared. Defects with exposed bone, larger graft sizes, preoperative radiation and immunosuppression may result in decreased graft take and increased complications.
Citation Format: Xue Zhao, Scott Mclean. Comparison of full-thickness versus split-thickness skin graft reconstruction of scalp defects [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; April 23-25, 2017; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(23_Suppl):Abstract nr 24.