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 (Altrazealâ„¢, 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.
After achieving hemostasis, 10mg of a sterile, biologically inert polymerized methacrylate powder dressing (Altrazealâ„¢, 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
