DS17: Results of a clinician questionnaire assessing the design and feasibility of the SeCondary intention versus grAfts for heaLing scalP wounds study (SCALP)

William Hunt,¹ Jasmine Mann,² Iqra Ashraf,³ Dushyanth Gnanappiragasam,⁴ Richard Barlow,⁵ Aaron Wernham,⁶ Rachel Abbott⁷ and Claudia DeGiovanni⁸

¹Dermatology Department, University Hospitals Plymouth NHS Trust, Plymouth, UK; ²Dermatology Department, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK; ³Dermatology Department, South Warwickshire NHS Foundation Trust, Birmingham, UK; ⁴Dermatology Department, University Hospitals of Leicester NHS Trust, Leicester, UK; ⁵Dermatology Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK; ⁶Dermatology Departments, Walsall Healthcare NHS Trust, Walsall, UK; ⁷Welsh Institute of Dermatology, Cardiff and Vale University Local Health Board, Cardiff, UK; and ⁸Dermatology Department, University Hospitals Sussex NHS Foundation Trust, Brighton, UK

Scalp defects not amenable to direct closure following dermatological surgery can be left open for secondary intention healing (SIH) or repaired with a graft or flap. No head-to-head comparison has been undertaken comparing these options to determine the optimal surgical outcomes or patient preference. Our UK Dermatology Clinical Trials Network group is designing and determining the feasibility of conducting a randomized controlled trial (RCT) comparing full-thickness skin grafts (FTSG) vs. SIH for small-to-moderate-sized scalp wounds not amenable to primary closure. As part of feasibility assessment, a 15-item questionnaire (SurveyMonkey™) was distributed to British Society for Dermatological Surgery members in July 2021. There were 56 responses; of these 53 (95%) of respondents were not aware of previous work addressing this area. Furthermore, 50 (89%) felt a RCT comparing FTSG vs. SIH healing in scalp wounds not amenable to primary closure would be beneficial for patients and the National Health Service. This was substantiated with 27 open comments. Most respondents (n = 30; 54%) stated that 5–9 departmental cases per week could be eligible for the study. When asked, 20 (36%) respondents had queries or concerns regarding the study. Thematically, these represented strong preferences for either FTSG or SIH, concerns around timing/capacity to undertake FTSG and preferred use of local flaps (n = 3/20). These responses demonstrate the variation in opinion and current practice among clinicians. Moreover, respondents reported their first preference for repairing small-to-moderate-sized scalp wounds not amenable to direct closure by: SIH healing (n = 31/53); FTSGs (n = 18/49); local flaps (n = 4/39); and split-thickness skin grafts (n = 2/24). Regarding the maximum defect size suitable for the study, the mode response was 3 cm (n = 16/52; 31%), followed by 5 cm (n = 12/52; 23%). When questioned, 36 (64%) respondents felt purse-string sutures could be used in the SIH arm on clinician discretion. Respondents were largely split on whether partial closures with FTSG of remaining defects were eligible [not eligible 28/53 (53%); eligible 25/53 (47·2%)]. For wound healing, 45/54 (83%) respondents would feel comfortable leaving a small-to-moderate-sized scalp wound excised to periosteum to heal by SIH with appropriate dressings. Interestingly, 18 (32%) reported typically giving topical or oral antibiotics for wounds managed either with SIH or FTSG. For hair-bearing scalp surgical site preparation, 35 (62%) would routinely remove scalp hair prior to surgery on the day using electric clippers. Others used a manual razor on the day (n = 5; 9%) and four (7%) would not remove hair. Most respondents felt follow-up for 6 (n = 21; 37%) or 12 (n = 19; 34%) months would be sufficient to determine final study outcomes. In conclusion, we present the results of a clinician questionnaire to assist with determining the design and feasibility of a RCT assessing scalp wound management following defects not amenable to primary closure.