Advancements in Dermal Substitutes for Head and Neck Reconstruction

The goal of head and neck reconstruction is to restore tissue form, aesthetics, and function. Skin is comprised of three primary structures: epidermis, dermis, and hypodermis. Replacement of these structures is particularly challenging in the face, scalp, and neck. Head and neck tissues vary greatly in thickness as well as in response to surgical manipulation. Limitations exist with traditional skin grafting techniques including donor site morbidity and size of the tissue defect. Dermal substitutes were developed to address these limitations providing a biological dressing that allows for wound healing through neovascularization, cellular proliferation, migration, elaboration of extracellular matrix proteins, and improved cell communication through enhanced cytokine and growth factor signaling. In this chapter, we review commonly used dermal substitutes, primary indications for soft tissue reconstruction, recommended protocols for use, clinical examples, and future developments.