Skin cancers and dermal substitutes: Is it safe? Review of the literature and presentation of a 2‐stage surgical protocol for the treatment of non‐melanoma skin cancers of the head in fragile patients

Abstract

Non-melanoma skin cancers (NMSC) represent the most common skin tumours of the head region. We describe the use of dermal substitute in a 2-stage surgery protocol for selected fragile patients to remove NMSC of the head region. A review of the literature focusing on dermal substitutes' safety after skin tumours excision is provided. A total of 45 fragile patients with NMSC in the head region were selected and scheduled for the 2-stage surgical protocol. The first stage consisted of traditional surgical excision and immediate coverage with Hyalomatrix (Fidia Advanced Biopolymers, Abano Terme, Italy). After histology confirmed diagnosis and clearance of the margins, full-thickness skin autografts were performed. All of the patients reached complete tumour excision and wound healing. No local recurrences were registered during 24 months follow up. The 2-stage surgical therapeutic-diagnostic-reconstructive approach represents a less stressful and oncologically safe surgical protocol in selected fragile patients. When patients cannot tolerate invasive and long surgical procedures, general anaesthesia, and long hospitalisation, skin grafting following temporary skin substitute coverage can achieve oncological clearance and provide good functional and aesthetic results. The use of dermal substitutes represents a valid alternative surgical option in cases of ASA III, fragile patients non-eligible for complex reconstructive surgery. To our knowledge, this is the first paper reviewing literature focusing on dermal substitutes' applications and safety after skin tumour excision.

Wound Healing after Acellular Dermal Substitute Positioning in Dermato-Oncological Surgery: A Prospective Comparative Study

“…Despite being widely used in reconstructive surgery, ADMs lacked standardized randomized controlled trials supporting their efficacy in the dermatological setting [ 34 , 35 , 36 , 37 , 38 ]. More data are currently available on their use in breast reconstruction after mastectomy, where ADMs are becoming routinely employed [ 39 ].…”

Skin and composite grafts

“…In chronically inflamed or non-healing wounds, the inflammatory process inherent to the wound results in degradation of these components and prevention of normal healing. Skin substitutes essentially act as a scaffold, providing various combinations of cells, growth factors, and extracellular matrix components, depending on the specific product, with the ultimate goal of facilitating revascularization and reepithelialization of a given wound [14,15] .…”

“…Perhaps the primary advantage of these products is the lack of donor site morbidity. Another relevant advantage is the potential for utilization of a large amount of material, as the availability is not limited by traditional donor site restrictions [14,15] . Conversely, there are challenges associated with product development and refinement, including the need for substantial research and investment in biocompatibility and application-specific optimization.…”

“…In parallel with these development challenges lies the primary barrier to widespread adoption: high cost. At this time, there is limited availability of most of these products outside of large hospital systems [14,15] . Skin substitutes may be utilized in various capacities, depending on the molecular composition and physical properties of a particular product [14,15] .…”

“…At this time, there is limited availability of most of these products outside of large hospital systems [14,15] . Skin substitutes may be utilized in various capacities, depending on the molecular composition and physical properties of a particular product [14,15] . Commonly described uses include the utilization of these products in the management of burns and chronic wounds, including chronic venous ulcers, diabetic foot ulcers, and pressure ulcers.…”