Vacuum-assisted closure device and skin substitutes for complex Mohs defects.

Cunningham, Teresa; Marks, Malcolm

BACKGROUND Soft tissue defects created by excision of dermatologic malignancies may present a significant challenge to the reconstructive surgeon, particularly when tendon, bone, cartilage, or other vital structures are exposed. Although there are several reliable options for regional or free tissue transfer, many patients with skin cancers are poor surgical candidates. Recent literature has described the use of an acellular dermal regeneration template (ADRT) (Integra LifeSciences Corp, Plainsboro, NJ) with split-thickness skin grafting (STSG) as an alternative to the previously mentioned surgical options. OBJECTIVE To use ADRT with negative-pressure wound therapy (NPWT) and STSG to reconstruct complex Mohs defects of the scalp and feet. MATERIALS AND METHODS Two patients underwent wide local excision of squamous cell carcinomas of the skin. ADRT and a NPWT device were applied. The patients were then skin grafted 7 to 10 days later. RESULTS Both patients had take of their skin grafts and completely healed their wounds without local recurrence. Results were both functionally and aesthetically satisfactory. CONCLUSION The use of ADRT with vacuum-assisted closure followed by split-thickness skin grafting is an acceptable alternative to regional or free tissue transfer for reconstruction of complex Mohs defects.