Artificial dermis (Matriderm®) followed by skin graft as an option in dermatofibrosarcoma protuberans with complete circumferential and peripheral deep margin assessment

Abstract

Dermatofibrosarcoma protuberans (DFSP) is a locally invasive neoplasia with a pattern of infiltrative growth that leads to extended resections. To avoid unnecessary resections and spare tissues, its treatment requires an adequate assessment of the margins. We present a case where artificial dermis (Matriderm®) was used followed by skin graft for reconstruction. We present a 50-year-old woman with a DFSP in the occipital region. She was referred to us after a first surgery with positive margins. A wide local excision with a 2-cm margin was performed and periosteal tissue was also removed, which led to exposure of the skull. Matriderm was placed on the bone surface and dressings were changed every other day. Meanwhile, margins were evaluated by the complete circumferential and peripheral deep margin assessment (CCPDMA) and were positive for DFSP in the superior margin. After 4 weeks the area was completely covered by granulation tissue and a new resection followed by reconstruction with a skin graft was performed. With regard to the difficulties in the margin assessment in DFSP, we present artificial dermis (Matriderm) as an option for reconstructive surgery in these patients, especially when a skin graft cannot be performed as a first option.

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

“…It is also a simple procedure when compared to microsurgical flap and can be performed in previously irradiated areas, allowing wound cover in complex resection areas, better local control of the disease, and early detection of recurrence. The need for experienced surgeons, weekly returns to dressing change, high product cost, and inability to use artificial dermis on wounds with exposed dura mater [5, 7, 10] can be pointed out as disadvantages.…”

“…More recently, Matriderm and Integra use in oncology and reconstructive surgery has also been reported [10–12]. These reports show no difference in oncological outcomes and are technically feasible.…”

Immediate Near-Total Scalp Reconstruction with Artificial Dermis on Exposed Calvarium

“…Alternatively, FTSG is associated with lower risk of contracture, but is not appropriate for large defect coverage [ 1 ]. STSG is effective for large defect coverage due to minimal donor site morbidity, but again requires a well-vascularized wound bed, and cannot be applied over bone without intact periosteum [ 5 6 ]. Therefore, two-stage reconstruction is needed.…”

Simultaneous dermal matrix and autologous split‐thickness skin graft transplantation in a porcine wound model: A three‐dimensional histological analysis of revascularization

“…It has been established that epithelial resurfacing and vertical proliferation were reduced and delayed by application of dermal matrices without affecting apoptosis, cell differentiation, or basement membrane formation . Previous clinical reports have also shown the feasibility of simultaneously applying thin split‐thickness skin grafts over a collagen–elastin matrix for full‐thickness skin reconstruction in burns or cancer reconstruction but lacked an explanation on how the applied skin grafts received nutrients, in other words: how the “mechanism of take” of the skin graft occurred.…”