INTRODUCTION
Nasal defects after Mohs micrographic surgery have a myriad of closure and reconstruction methods, including second intention, split or full-thickness skin grafts, local flaps, and pedicled flaps. Commonly, for superficial and smaller defects of the nose, second-intention healing results in cosmetic outcomes that are arguably superior to that of surgically sutured repairs.1-3 This is especially true in the concave areas of the nose, such as the nasal sidewall, alar crease, and lateral nasal dorsum, where naturally shadowed contours hide light reflex or pigmentation differences normally revealing of nasal scars.2 When used for appropriate wounds based on location, size, depth, and patient preference, second-intention healing has many advantages, including decreased overall surgical time, a smaller scar profile, and high levels of patient satisfaction.4 However, its main disadvantages are prolonged healing time, daily bleeding and drainage from open wounds, and the possibility of wound infection.5 Biologic dressings, or skin substitutes, are a useful option to overcome these disadvantages of second intention healing, with increasing use on acute surgical wounds to improve healing time, reduce wound complications, and alleviate the healthcare cost of prolonged wound care.
As of the last analysis in 2020, around 76 skin substitutes have been developed and commercially available in the United States.6 While the majority of these products are designed for use in chronic non-healing wounds, their utility in the acute post-surgical setting has been recognized and increasingly explored.7-13 Many different classification schemes have been utilized in the literature, categorized by cellular composition (amnion, epithelial, acellular allograft, cellular allograft, xenograft, composites, synthetics) and by intended skin layer replacement (epidermal, dermal, composite epidermal, and dermal).6 To date, there have not been robust comparisons of products in terms of wound healing efficacy. Therefore, the selection of skin substitutes for regular use on acute surgical wounds is based on physician familiarity, overhead cost of the product, shelf life, insurance coverage, and patient considerations such as the need for frequent return visits for graft reapplication or wound debridement.
The authors have found bovine-derived collagen wound dressing (Puracol®, Medline Industries, Inc; Mundelein, IL) to be a cost-efficient workhorse skin substitute. As a xenograft, Puracol® is bovine-derived type 1 collagen in its native triple-helix formation, consisting of 88.4% collagen.14 Its affordability,
As of the last analysis in 2020, around 76 skin substitutes have been developed and commercially available in the United States.6 While the majority of these products are designed for use in chronic non-healing wounds, their utility in the acute post-surgical setting has been recognized and increasingly explored.7-13 Many different classification schemes have been utilized in the literature, categorized by cellular composition (amnion, epithelial, acellular allograft, cellular allograft, xenograft, composites, synthetics) and by intended skin layer replacement (epidermal, dermal, composite epidermal, and dermal).6 To date, there have not been robust comparisons of products in terms of wound healing efficacy. Therefore, the selection of skin substitutes for regular use on acute surgical wounds is based on physician familiarity, overhead cost of the product, shelf life, insurance coverage, and patient considerations such as the need for frequent return visits for graft reapplication or wound debridement.
The authors have found bovine-derived collagen wound dressing (Puracol®, Medline Industries, Inc; Mundelein, IL) to be a cost-efficient workhorse skin substitute. As a xenograft, Puracol® is bovine-derived type 1 collagen in its native triple-helix formation, consisting of 88.4% collagen.14 Its affordability,
