BACKGROUND: The incidence of skin tumors is increasing among elderly patients, and the multi-morbidities which occur in the elderly are a great challenge for dermatologic surgeons. The currently required safety margins for different types of melanomas and non-melanoma skin cancers lead to extensive and profound wounds. OBJECTIVE: To investigate the usefulness of a dermal substitute (Integra®) for routine use in surgery for dermatologic tumors. PATIENTS AND METHODS: In this retrospective study 20 patients underwent sequential surgeries for skin cancer. Wound closures were performed using Integra® (single layer) and immediate split-thickness skin graft. RESULTS: Twenty-two tumors (6 malignant melanomas, 10 squamous cell carcinomas, 2 pleomorphic sarcomas, 1 basal cell carcinoma, 2 Merkel cell carcinomas, and 1 trichoblastic carcinoma) were resected. The mean defect size was 41.4 cm(2) . All transplants were (65-100 %) vital; however, defects in the midface (cheek and infra-orbital area) often healed with esthetically disturbing, dense, pillow-like scars. CONCLUSIONS: With the use of Integra®, the duration of hospitalization was decreased, patients with multi-morbidities were effectively treated, and functionally- and esthetically-satisfactory outcomes were achieved. On the basis of these observations, we discuss points of handling those patients who require rapid and effective surgery and undergo dermatologic surgery using dermal substitutes.
BACKGROUND: The incidence of skin tumors is increasing among elderly patients, and the multi-morbidities which occur in the elderly are a great challenge for dermatologic surgeons. The currently required safety margins for different types of melanomas and non-melanoma skin cancers lead to extensive and profound wounds. OBJECTIVE: To investigate the usefulness of a dermal substitute (Integra®) for routine use in surgery for dermatologic tumors. PATIENTS AND METHODS: In this retrospective study 20 patients underwent sequential surgeries for skin cancer. Wound closures were performed using Integra® (single layer) and immediate split-thickness skin graft. RESULTS: Twenty-two tumors (6 malignant melanomas, 10 squamous cell carcinomas, 2 pleomorphic sarcomas, 1 basal cell carcinoma, 2 Merkel cell carcinomas, and 1 trichoblastic carcinoma) were resected. The mean defect size was 41.4 cm(2) . All transplants were (65-100 %) vital; however, defects in the midface (cheek and infra-orbital area) often healed with esthetically disturbing, dense, pillow-like scars. CONCLUSIONS: With the use of Integra®, the duration of hospitalization was decreased, patients with multi-morbidities were effectively treated, and functionally- and esthetically-satisfactory outcomes were achieved. On the basis of these observations, we discuss points of handling those patients who require rapid and effective surgery and undergo dermatologic surgery using dermal substitutes.
Authors: Marco Marcasciano; Marco Mazzocchi; Juste Kaciulyte; Noemi Spissu; Donato Casella; Diego Ribuffo; Luca Andrea Dessy Journal: Int Wound J Date: 2018-06-04 Impact factor: 3.315