Skin Substitutes and Biologic Agents for Wound Closures after Melanoma Resection

Abstract

Wound healing is a highly complex process mediated by microscopic cellular interactions. An improved understanding of the physiology of wound healing has laid the groundwork for translational research to create biologic wound care technologies that have significantly impacted patient care. Biologic wound technologies have broad applications and have had a significant impact on the reconstructive ladder, as the reader will see throughout this chapter. Despite their frequent use, many surgeons are unfamiliar with the plethora of products on the market, as well as each product’s relative advantages and disadvantages. This chapter will go over oncologic reconstruction of the nose, scalp, lip, cheek, and extremities after wide local excision of melanomas in these areas, which is a significant challenge for plastic surgeons. Traditional methods for reconstructing these defects include primary closure techniques, skin grafts, local flaps, pedicled flaps, and free tissue transfer; however, the increased risk of metastasis associated with melanoma makes it difficult to use biologic wound healing agents like Integra and Cytal as alternative reconstructive options without causing additional donor site morbidity. In this chapter, we examine the use of biological agents in soft tissue reconstruction, including the surgical approaches, complications, and limitations of various reconstructive methods.