136 Reconstruction of Recurrent first Dorsal Web Space Oncologic Defects with Acellular Dermis

Abstract

Introduction: Open wounds following oncologic reresection of skin cancer of the hand can be problematic from a soft tissue reconstructive perspective. First, these wounds must often await definitive coverage until permanent negative margin clearance is obtained. This results in the morbidity of chronic painful dressing changes and possible infection. Secondly, for defects of the first web space, the reconstructive options are often limited to skin grafting which can yield functional hazards with contracted healing. Acellular dermis has been proposed as a biomechanical scaffold for subsequent skin grafting. Hypothesis: We proposed to use acellular dermis for wounds stemming from reresection of skin cancers of the first web space to: 1) obviate dressing changes until permanent histology was confirmed 2) provide a soft tissue platform that enhances subsequent skin graft take and healing and ameliorates potential graft contracture Methods: The resected wound area of two patients, 11 × 5 and 5 × 4 cm in size, were transiently covered with acellular dermis in the first stage. After confirmation of final histologic clearance of tumor at the margins, split thickness skin graft was placed on the granulating wound bed. Subsequent clinical examination and DASH questionnaires were used to assess outcome. Results: After 6 months, wounds had healed with good cosmetic result. No contracture of the web space was noted. Average DASH score was 20.5 and no recurrences were noted. Conclusion: Our observations suggest that acellular dermis is a useful adjunct for covering wounds of the hand, especially for functionally important locations such as the first dorsal web space.