Reconstruction of Post-Mohs Surgical Wounds Using a Novel Nanofiber Matrix

Joseph McGowan, MD

Disclosures

Wounds. 2022;34(8):209-215. 

In This Article

Abstract and Introduction

Abstract

Introduction: Surgical wound healing after Mohs micrographic surgery can be challenging. Achieving an optimal aesthetic outcome is another important consideration, especially for facial lesions.

Objective: This case series evaluates the use of a novel synthetic nanofiber matrix after Mohs surgery to achieve desired results.

Materials and Methods: Four patients with NMSCs on the auricular helix underwent Mohs micrographic surgery at a single cancer center. The synthetic nanofiber matrix was applied to the prepared Mohs surgical defect and covered with a dressing. The wounds were evaluated regularly for healing progress, and an additional synthetic nanofiber matrix was applied as needed.

Results: Wounds were treated with an average of 1.25 applications ± 0.50 standard deviation of synthetic nanofiber matrix. The initial average wound size was 11.8 cm2. All wounds healed in 7.9 weeks ± 4.2 with excellent aesthetic results, minimal scar formation, and no skin deformity. In cases with exposed structures (cartilage and perichondrium), the synthetic nanofiber material promoted complete closure and healing. No complications were reported. Treatment using a synthetic nanofiber matrix resulted in complete wound healing in all patients.

Conclusions: This study shows the synthetic nanofiber matrix is a viable option for the reconstruction of post-Mohs surgical defects.

Introduction

Mohs micrographic surgery is a common procedure used to remove NMSCs and melanoma skin cancers on the head and neck. Mohs surgery and tumor removal results in a tumor-free surgical defect. Postoperative wound healing after Mohs surgery often is challenging, depending on tumor size, location, and depth, as well as the prevalence of exposed underlying structures.[1] Achieving an aesthetic outcome may be an additional expectation, especially for facial lesions.[2] Depending on the patient's medical comorbidities, wound size and/or location, and surgeon-specific preferences, multiple reconstructive approaches may be considered.

One simple method for wound healing involves allowing the wound to self-heal by contraction and epithelialization. In a study of 38 patients with postoperative defects with exposed bone who underwent secondary intention healing, time to epithelialization was 13 weeks.[3] This method works well for small circular wounds; however, second intention healing may result in distortion and poor aesthetic outcomes for larger wounds and in certain anatomic locations.[4] Alternatively, a common, very simple reconstructive approach is the use of a FTSG. In a clinical study of 50 patients, lower leg defects were treated with FTSGs.[5] Thirty days after application, 90% or higher graft take (as an outcome of treatment success) had occurred in 44 patients. Although studies show variable rates of postoperative graft survival, complications associated with skin grafts include graft rejection (10%), infection (11%), and hematoma formation (2.5%).[1] Moreover, skin grafts require an additional surgery to harvest the skin from the donor site, thus increasing the rate of postoperative complications, the potential for donor site morbidity, and, often, the total cost of care.

A newer method to treat wounds after Mohs micrographic surgery involves the use of a synthetic nanofiber matrix, such as Restrata (Acera Surgical, Inc.), which is an electrospun biodegradable synthetic nanofiber matrix with an architecture similar to that of human ECM.[6] This product received US Food and Drug Administration 510(k) clearance in early 2017.[7] The synthetic nanofiber matrix has a range of fiber diameters and pore sizes that mimic the hierarchical organization of native tissue, and thus support cellular ingrowth, retention, neovascularization, and granulation tissue formation.[6] As the fibers gradually degrade over time the porosity opens further, allowing for additional tissue ingrowth and skin regeneration. The synthetic matrix is composed of 2 biocompatible polymers: PLGA (10:90) and polydioxanone. The matrix conforms well to the wound site, due to its flexibility, and has excellent biocompatibility properties. Because of its unique design, the synthetic nanofiber matrix persists in the wound bed, slowly degrades via hydrolysis, and is resistant to enzymatic degradation. The engineered properties and ease of use of the synthetic nanofiber matrix offer an alternative to existing amniotic, allogenic, and/or biologic products, providing a terminally sterilized product with a 2-year shelf life at room temperature that does not require tissue tracking.[7]

A previous study evaluating chronic lower extremity wounds showed that wounds treated with the synthetic nanofiber matrix demonstrated progressive wound area reduction over the course of treatment and that the matrix could support the natural wound healing process.[8] The current study evaluates the efficacy of the synthetic nanofiber matrix for treating wounds after Mohs micrographic surgery in 4 patients. Following application of the synthetic nanofiber matrix, wounds were monitored to evaluate how the material supported the healing process.

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