INTRODUCTION
Surgical treatment, with Mohs micrographic surgery (MMS) or standard surgical excision, is the standard of care for nonmelanoma skin cancers and primary cutaneous melanomas.1-3 The surgical defects created by tumor extirpation may range from a few millimeters to several centimeters. Depending on the defect size, location, and cosmetic goals of the patient, repair options include second intention healing (SIH), primary closure, skin flaps, and skin grafts. In addition, a plethora of biologic dressings have been introduced over the last 40 years to facilitate healing, with variable evidence supporting their use.
Many skin cancers develop on the distal lower extremities and feet, especially in fair-skinned individuals who have had heavy sun exposure. Surgical defects in these areas are often difficult to close primarily and pose a reconstructive conundrum. For patients with poor skin quality, older age, limited skin laxity, or vascular disease, more conservative approaches such as SIH may be appropriate. SIH has many advantages, including reduced initial procedure time, avoidance of secondary wound or larger surgical site, smaller scar due to contraction, and better cosmetic and functional outcomes when compared with full-thickness skin graft.4
Many skin cancers develop on the distal lower extremities and feet, especially in fair-skinned individuals who have had heavy sun exposure. Surgical defects in these areas are often difficult to close primarily and pose a reconstructive conundrum. For patients with poor skin quality, older age, limited skin laxity, or vascular disease, more conservative approaches such as SIH may be appropriate. SIH has many advantages, including reduced initial procedure time, avoidance of secondary wound or larger surgical site, smaller scar due to contraction, and better cosmetic and functional outcomes when compared with full-thickness skin graft.4
SIH is an easy, low-cost repair option that should be considered for surgical defects of the distal lower extremity, but it does have disadvantages that include prolonged healing and wound care and the risk of postoperative bleeding.4,5 Because of these limitations, placement of biologic dressings should be considered for patients who would otherwise undergo SIH.
Biologic dressings (also known as skin substitutes or biologic skin substitutes) are helpful for healing burns, chronic wounds, blistering diseases, and postsurgical defects. The dressings are designed to accelerate wound healing by replacing components of the extracellular matrix.6 They are categorized as composite, dermal, or epidermal, and can be further divided based on their origin. The ever-expanding variety and availability of biologic dressings have led to multiple review articles and exploration of their utility in acute surgical wounds.6-18 Biologic dressings are reported to decrease postoperative pain and healing time compared with SIH; however, most lack controlled trials to
