Dermal Substitutes Use in Reconstructive Surgery for Skin Tumors: A Single-Center Experience

Abstract

Reconstructive surgery following skin tumor resection can be challenging. Treatment options after removing the tumor are skin grafting, local pedicled and axial flaps, or microsurgery for complex and extensive wounds correction. Recently, the use of dermal substitutes has been extended to reconstructive surgery in cutaneous oncology. Objectives. To report both a single-center experience using dermal substitutes in reconstructive surgery for skin malignancies and reconstructive surgery's outcomes. Methods and Results. Among thirteen patients, seven (53.8%) were male with mean age of 62.6 years. Regarding diagnosis, there were five cases (38.5%) of basal cell carcinoma (BCC), two (15.4%) of melanoma in situ, two (15.4%) of dermatofibrosarcoma protuberans, one (7.7%) of squamous cell carcinoma (SCC), one (7.7%) of angiosarcoma, and one (7.7%) of eccrine carcinoma (EC). The most common site of injury was scalp (53.8%) and lower limbs (23.1%). Seven (53.8%) patients used NPWT and six (46.2%) patients underwent Brown's dressing. The most frequent complication of the first stage was wound contamination (38.5%). Average time to second-stage skin grafting was 43.9 days. Three (23%) patients developed tumor recurrence and one died. Conclusions. Use of dermal substitutes in oncology can be an option for reconstruction after extended resections, providing good aesthetical and functional results.

Utilización de piel cadavérica (aloinjerto) en la preparación del lecho en úlceras de miembros inferiores

“…La reconstrucción mediante colgajos no suele ser una buena indicación, ya que generalmente, debido al defecto a cubrir, implicaría una gran morbilidad de la zona donante, tiempo operatorio y estancia hospitalaria prolongada en pacientes de edad avanzada. (1,16) La piel cadavérica es una alternativa válida para el tratamiento de úlceras crónicas. Ofrece una menor contracción de la herida, mayor elasticidad y grosor de la piel en relación con los autoinjertos.…”

“…Coincidiendo con este trabajo, nuestro paciente con evolución tórpida, que era de etiología arterial, requirió amputación del miembro inferior. Al igual que muestra el trabajo de Campagnari y col, (16) en nuestra serie los que utilizaron terapia de vacío tardaron más tiempo en cicatrizar que aquellos que utilizaron vendaje o apósitos de Brown, posiblemente debido a que los del primer grupo correspondían a úlceras más grandes y profundas.…”

“…Se asocia con un bajo prendimiento del autoinjerto. A su vez, el resultado puede ser propenso a la contracción y a una apariencia estética subóptima, ya que la dermis juega un rol fundamental en la regeneración cutánea (9,16,17). Existen otros tratamientos en la literatura, como la utilización de láser Erbium YAG o la aplicación en la úlcera de plasma rico en plaquetas, ambos con buenos resultados (18,19).…”

Human Acellular Dermal Matrix is a Viable Alternative to Autologous Skin Graft in Patients with Cutaneous Malignancy

“…13 In the field of surgical oncology, ADM has extensively been reported as a successful adjunct in breast reconstruction. 10 In regard to reconstruction of defects due to skin cancer resection, Campagnari et al 14 investigated the use of dermal substitutes for immediate, temporary coverage of skin cancer defects in 13 patients as a bridge to the second stage of reconstruction. They concluded their results were similar to existing data reported in the literature, with one patient forgoing the second stage of reconstruction because of evidence of complete epithelialization after 90 days, and an average of 43.9 days reported for time to second-stage procedure.…”

Artificial dermal substitutes for tissue regeneration: comparison of the clinical outcomes and histological findings of two templates

“…17 Biomaterials have been extensively investigated for use in skin replacement, and acellular DSs are fundamental to prepare the wound bed and enhance graft integration with the resultant recipient surface. Moreover, DSs are able to repair full-thickness cutaneous wounds and elicit effective wound healing, 18 and they are recommended in reconstructive surgery [19][20][21][22] because they provide adequate scaffolding to interpose fibroblasts and endothelial cells toward neodermis formation. [23][24][25][26] We conducted a randomized study to compare Pelnac and Integra, the two above-mentioned collagen acellular bilayer substitutes used to treat a variety of skin wounds.…”