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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Skin substitutes are an alternative that should be taken into account for reconstruction of skin defects&#46; This option is even more important when treating large defects or defects in which there is no sufficiently vascularized bed to enable viability of the graft&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The many types of skin substrates include the bilayer dermal wound matrix Integra&#44; which was introduced into clinical practice in Europe in 1996&#46; Since its development&#44; it has been widely used to treat burns and chronic ulcers and&#44; subsequently&#44; in the reconstruction of skin defects after removal of malignant tumors&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Technique</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 79-year-old man was treated for atypical fibroxanthoma on the scalp using fresh-tissue Mohs micrographic surgery&#46; This left a skin defect measuring 4&#8239; cm in diameter in the frontoparietal area&#46; The first stage&#44; which included the periosteum&#44; revealed a deep contact area in the center of the specimen&#46; Before reconstruction of the defect began&#44; the bone was drilled at this level&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The resulting defect was covered using the bilayer dermal wound matrix Integra&#46; This skin substitute is formed by a mesh of bovine collagen bound covalently to chondroitin-6-sulfate and covered by a layer of silicone&#46; It aims to favor proliferation of fibroblasts and collagen synthesis through the formation of a neodermis that enables the viability of a subsequent graft&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> as performed 4 weeks later with a split-thickness graft harvested from the thigh&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications&#47;Contraindications</span><p id="par0025" class="elsevierStylePara elsevierViewall">Reconstruction of skin defects of the scalp is hampered mainly by distensibility in the area&#46; Thus&#44; in defects greater than 3 &#8239;cm&#44; surgical options are limited to grafts and various types of plasty that involve mobilizing large volumes of tissue&#46; In this case&#44; the absence of a well-vascularized bed owing to removal of the periosteum hampered placement of a graft or healing by secondary intention&#46; Skin substitutes&#44; which are particularly useful in large defects&#44; come into their own in such cases&#46; Furthermore&#44; it is important to note that skin substitutes are a good option in older patients with comorbid conditions&#44; since the procedure is quick and reduces the risks associated with anesthesia&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In addition&#44; use after removal of aggressive tumors enables early diagnosis of possible recurrences&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The disadvantages of skin substitutes&#44; on the other hand&#44; include the need for 2 stages&#44; as well as a regimen of regular dressing with close follow-up of progress&#46; This approach is also costly&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Complications</span><p id="par0035" class="elsevierStylePara elsevierViewall">The main complications of this approach during the first stage of the procedure are infections and the formation of fluid collections&#44; which may prevent the matrix from attaching&#46; As for the second stage&#44; the main complication is necrosis of the graft over the matrix&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="par0040" class="elsevierStylePara elsevierViewall">Skin substitutes are an alternative worthy of consideration in the case of large skin defects with no sufficiently vascularized bed&#46; In addition&#44; they are not complex for surgeons to apply and reduce the risks associated with anesthesia&#46;</p></span></span>"
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