Two-step Xenogeneic Dermal Matrix-assisted Autologous Skin Grafting for Large Scalp Cutaneous Squamous Cell Carcinoma Ulcer

Summary:

Cutaneous squamous cell carcinoma (CSCC) of the scalp poses major reconstructive challenges, especially in older patients with poor surgical tolerance. Large postexcisional defects often require complex reconstruction, whereas free flaps and tissue expansion may be unsafe in high-risk individuals. We present a cost-effective, 2-stage approach using xenogeneic acellular dermal matrix (XADM) followed by autologous split-thickness skin grafting. The graft survived completely. Both scalp and donor site healed without infection or wound complications. Frozen sections confirmed negative margins, and final histopathology showed moderately differentiated CSCC without bone invasion. Telephone follow-up indicated durable wound healing without local breakdown until death. The patient died 13 months postoperatively from systemic progression of advanced CSCC rather than surgical complications; formal oncologic surveillance was not performed because of financial constraints. Two-stage XADM-assisted autologous skin grafting is a technically accessible, economical option for large scalp CSCC defects in older, high-risk patients, avoiding free flap morbidity while achieving satisfactory healing and oncologic safety. Prospective studies are warranted. An 82-year-old woman with severe malnutrition (41 kg, 155 cm, body mass index 17.07 kg/m ² ), cancer-associated cachexia, frailty, and American Society of Anesthesiologists class III presented with an 8 × 9 cm scalp ulcer. Biopsy showed moderately differentiated CSCC. After wide excision with 2.0-cm margins in the subgaleal plane, leaving a 12 × 13 cm defect, the wound was covered with a porcine-derived XADM. Sixteen days later, the matrix was removed, revealing a healthy granulation bed, and an autologous split-thickness skin graft harvested from the dorsal back was applied.