Methacrylate Polymer Powder Dressing for a Nasal Surgical Defect

December 2019 | Volume 18 | Issue 12 | Case Reports | 1274 | Copyright © December 2019

Matthew J. Lin MD,ª Danielle P. Dubin BA,B Aaron S. Farberg MD,B Hooman Khorasani MD,ª David A. Kriegel MDª

aDivision of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
bDepartment of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY

Abstract
The fusion of technology and medicine has led to the advent of advanced wound healing techniques that may be adapted to the management of surgical defects. Shortened duration of healing and ease-of-use are two potential benefits under investigation. Here we describe a 65-year-old male with a nasal alar wound that was allowed to heal with secondary intention, assisted by a novel methacrylate polymer powder dressing.

J Drugs Dermatol. 2019;18(12):1274-1275.

BACKGROUND

Advances in technology have recently contributed to the development of innovative wound healing modalities that hold promise for the management of surgical defects.

CASE

65-year-old Caucasian man presented with a biopsy-proven nodular basal cell carcinoma on the left nasal alar. The tumor was cleared after 2 stages of Mohs Micrographic Surgery with excision down to the nasalis muscle. The resultant defect measured 12mm x 14mm in area and 5mm in depth (wound size 840mm3). Reconstructive options were discussed, including random pattern flap repair, skin graft and secondary intention healing with the aid of a novel methacrylate powder dressing.The patient preferred to proceed with secondary intention healing assisted by the methacrylate powder dressing.

After achieving hemostasis, 10mg of a sterile, biologically inert polymerized methacrylate powder dressing (Altrazeal™, Uluru Inc., TX) was poured over the wound in a uniform layer to fill and seal the entire surface. 0.1ml of sterile ionic saline was sprayed onto the powder to activate the dressing. The single dressing was left intact for 3 weeks. A post-operative follow-up visit at 3 weeks found the wound completely epithelialized and reduced in size to 9 x 10mm in area and 1mm in depth (wound size volume 90mm3). This represented a 90% reduction in wound (Figure 1). The dressing was easy to maintain, non-painful, and there were no reported adverse effects.

DISCUSSION

Polymerized methacrylate powder dressings are a novel, sophisticated dressing modality with great potential in the management of wounds following cutaneous surgery. The dressing used in this case was a lyophilized, sterile powder consisting of 84.8% poly-2-hydroxyethylmethacrylate, 14.9% poly-2-hydroxypropylmethacrylate (pHPMA), and 0.3% sodium deoxycholate. These hydrophilic polymers have a covalent methacrylate backbone with a hydroxyl aliphatic side chain. When saline or wound exudate contacts the powder, the spheres hydrate and non-reversibly aggregate to form a moist, flexible dressing that conforms to the topography of the wound and seals it (Figure 2).1