Treatment of full-layer skin defects using decellularized pig skin dermal matrix

Abstract

The choice of treatment methods for complex skin defects poses certain technical and medical difficulties related to the choice of material for filling the wound defect and its antigenic compatibility. A promising direction in the treatment of skin defects is the use of decellularized (celluless) pig skin, the composition and structure of which is as close as possible to the patient's dermis.
 The aim of the study was to analyze the clinical case of a patient with a basal cell carcinoma in the right wing of the nose, who was treated with full-layer skin defects using a decellularized dermal matrix from pig skin.
 Material and methods of investigation. Patient P., 94 years old, with a basal cell carcinoma in the area of the right wing of the nose, underwent treatment. As a material applied directly to the wound, a flap of acellular dermal matrix (ADM) of pig skin with preservation of the native structure was used.
 Results. 6 weeks before the visit to the dermatologist, the patient developed a pea-sized papule on the skin in the area of ​​the wing of the nose, which increased in size and became painful on palpation. When examining the skin in the area of ​​the right wing of the nose, a tumor-like formation was observed, 1x1 cm in size, flesh-colored, with peeling on the surface and vascularization, firm consistency, painful. Regional lymph nodes are not enlarged. The formation is clearly separated from healthy skin. The oncologist made a diagnosis: basal cell carcinoma. The tumor was removed, resulting in a full-layer skin defect measuring 1x1.5 cm with connection to the nasal cavity. Acellular dermal matrix was used to close the defect on the 3rd day after surgery. The flap was placed so that it did not cover the skin around the wound. With the help of "Levomykol" ointment, a moist chamber was created over the dermal flap. The dressing was changed every 2-3 days. On the 14th day, the flap peeled off, a granulating wound with signs of marked marginal epithelization formed in its place. The bottom of the wound was located almost at the same level as the intact skin. On the 21st and 26th day, active marginal epithelization of the wound and wound healing under the scab were noted. The bandage was not used during this period. On the 32nd day, the wound closed.
 Conclusions. Decellularized dermal matrix of pig skin when closing a full-layer postoperative skin defect creates optimal conditions for reparative wound regeneration. The effectiveness of its use is due to the presence of a collagen matrix in it, from which the nuclear elements of cells have been removed, which does not lead to immune aggression. The clinical case proves the expediency of using the decellularized dermal matrix of pig skin in the treatment of full-layer skin defects of various genesis.