One-stage reconstruction of deep facial defects with a single layer dermal regeneration template

Abstract

Background: The reconstruction of deep facial wounds in oncological surgery is challenging. Especially for elderly multimorbid patients, a rapid procedure with acceptable aesthetic and reliable functional outcome is required. Recently, a new single layer skin substitute was developed. Integra® dermal regeneration template single layer (IDRT-SL) allows one-stage surgery in combination with split thickness skin grafting. However, no study has yet analysed the efficiency of IDRT-SL treatment.

Objectives: To evaluate applicability and efficiency of the IDRT-SL treatment in combination with split thickness skin grafting for a one-step closure of deep facial surgical wounds in elderly multimorbid patients.

Patients/methods: This prospective study analysed the functional and aesthetic outcome after reconstruction with an IDRT-SL template and an immediate split thickness skin graft in the face (80±3 years; >3 concomitant diseases).

Results: Nine tumours, four basal cell carcinoma, two lentigo maligna, one spinal cell carcinoma, one lentigo maligna melanoma and one Bowen carcinoma were resected. Five defects were located on the nose and four on the cheek. The mean defect size was 11±3 cm2. All but one graft were taken completely without any complication. One patient suffered from a partial graft loss (30%). All defects showed significant shrinkage of 61±4%.

Conclusions: One-stage reconstruction with a combination of IDRT-SL and split thickness skin grafting is an elegant, easy and rapid method to treat deep skin defects. The take rates, functional and early cosmetic outcome are promising. This new method should be considered for selected cases of elderly multimorbid patients with deep facial wounds.