Use of Biologic Agents in Nasal and Scalp Reconstruction

Abstract

Oncologic reconstruction of the nose and scalp following Mohs micrographic surgery poses a significant challenge for plastic surgeons. While these defects are traditionally reconstructed using primary closure techniques, skin grafts, local flaps, pedicled flaps, and free tissue transfer, the incorporation of biologic healing wound agents such as Integra and Cytal provides patients and surgeons with alterative reconstructive options without additional donor site morbidity. Herein, we review the use of biologic agents used in soft tissue reconstruction of the nose and scalp following Mohs surgery.

Skin Substitutes and Biologic Agents for Wound Closures after Melanoma Resection

“…Our institution has focused on increasing the use of biologic wound-healing therapies for scalp reconstruction after oncologic resections more recently [46]. Biologic wound-healing agents provide constant, dependable results with high success rates and very few downsides when used in conjunction with color-matched split-thickness skin grafts.…”

“…Our institution now uses a Depani et al algorithm to direct the use of biological agents in nasal reconstruction [46]. The strength of these therapies is their capacity to expedite healing without requiring delayed full-thickness skin grafting, which is especially important for reconstructions.…”

Current and Future Developments in Wound Healing

“…Bioengineered skin substitutes have also been increasingly used to overcome the disadvantages of skin grafting and associated donor site morbidity. Current applications for tissue substitutes in the head and neck literature include reconstruction of large scalp 33,34 and face/temporal region defects, radial forearm free flap donor site coverage, 35 nasal reconstruction, [36][37][38] and intraoral mucosal (buccal mucosa, floor of mouth, and lateral/ventral tongue) reconstruction 39,40 after oncologic resection. Use of Integra bilayer wound matrix (Integra LifeSciences, Plainsboro, NJ) has been described as a reasonable reconstructive solution for denuded avascular wounds including irradiated tissue, bare calvarial bone (►Fig.…”

“…33,36 When used as a staged reconstruction in conjunction with skin grafting, one may accomplish enhanced skin tone matching and improved cosmesis; however, single-staged procedures may be beneficial for elderly patients, patients with multiple medical comorbidities, or those who prefer to avoid a second surgery. 36,38 Negative Pressure Wound Therapy Negative pressure wound therapy (NPWT) has been shown to be an effective treatment in accelerating wound healing and has been implemented in the management of infected wounds, chronic wounds, open-staged wounds, and postirradiated wounds. Its widespread use in the head and neck, however, has been limited due to the challenge of securely placing the device and maintaining an appropriate seal along various surface contours on the head and neck.…”