Background A bilaminate skin substitute consisting of a thin outer layer silicone membrane with an inner layer of porous collagen-glycosaminoglycan (Integra) has been successfully used as an acellular dermal replacement in full-thickness wounds with a well-vascularized surgical bed. Approximately 2-4 weeks after Integra placement, full vascularization of the Integra neodermis occurs, which allows harvesting of a thin split-thickness skin graft (STSG) to cover the neodermis. The use of Integra is also known to suppress scar formation. Although the benefits of Integra have been widely studied in deep and full-thickness burn wounds, the use of artificial dermis post excision of malignant melanoma has not been reported.
Methods Ten patients (five men and five women; mean age 64 ± 16 years) with soft tissue defects (mean defect area, 69 ± 40 cm≤) following resection of malignant melanoma underwent immediate reconstruction with Integra. After adequate cancer resection, Integra was applied to the defect area until permanent histology was completed. An STSG (0.01 ± 0.003 inches in thickness) was placed on the operative site at postoperative day 39 ± 14 after the removal of the silicone layer. One patient received repeated application of artificial dermis post re-excision to augment a soft tissue defect. One patient required a leg amputation due to dissemination of the malignancy. After successful perioperative management of melanoma excision, two patients received serial excision of the grated area to improve the cosmetic result.
Results Clinically, all reconstructed areas showed well-vascularized neodermis before skin grafting. Eight out of 10 skin grafts had a 100% graft take. Notably, the two grafts requiring serial re-excision of the graft had reduced split-thickness graft take (67% and 85%). Melanoma excision, Integra placement, and STSG placement occurred in less than 2 and a half hours operative time. Besides re-excision for cosmetic reasons, no complications using Integra and STSG reconstruction were seen.
Conclusion Artificial dermis can be successfully used for reconstruction of complex defects following oncologic resection of malignant melanoma. The use of Integra decreases morbidity to the donor site, expedites operative time, and acts as a temporary closure until histologic margins are confirmed.
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