Ovine Forestomach Matrix as a Substrate for Single-Stage Split-Thickness Graft Reconstruction

Objective: Split skin graft reconstruction of scalp defects often leaves an obvious contour defect. Here, we aimed to demonstrate the use of a decellularized extracellular matrix biomaterial, termed ovine forestomach matrix (OFM), as a substrate for split-thickness skin grafts (STSGs) for scalp reconstruction. Methods: Following full-thickness tumor excision, OFM was applied directly to skull periosteum, and then an STSG was applied. Participants were monitored for graft take, epithelialization, and cosmetic outcomes. Results: Participants responded well to the procedure with more than 95% graft take in 4 participants, and 100% epithelialization of the grafts after 2 weeks. A 30% graft take was observed in the fifth participant due to local infection and partial necrosis of the graft. Ovine forestomach matrix was remodelled with time and the regenerated dermis was well vascularized and had robust and ordered collagen deposition. Conclusions: This series demonstrates that OFM can serve as a temporary dermal scaffold to support an overlying STSG and allow for a single-stage grafting procedure.