Reconstruction of a recurrent first dorsal web space defect using acellular dermis

Area of Science:

• Plastic Surgery
• Surgical Oncology
• Regenerative Medicine

Background:

• Hand oncologic defects pose reconstructive challenges, often delaying definitive coverage and increasing infection risk.
• Current reconstructive options like skin grafting can lead to functional deficits due to contracture.
• Acellular dermis is explored as a scaffold to enhance skin graft healing and mitigate contracture.

Purpose of the Study:

• To evaluate the efficacy of acellular dermis as temporary coverage for hand oncologic defects.
• To assess the functional and cosmetic outcomes of using acellular dermis followed by split-thickness skin grafting.

Main Methods:

• A case study involving reconstruction of an 11 cm x 5 cm defect in the first dorsal web space using acellular dermis.
• Temporary coverage with acellular dermis allowed time for margin assessment.
• Subsequent application of a split-thickness skin graft (STSG) over the neo-dermis.

Main Results:

• No melanoma recurrence observed at 7 months post-reconstruction.
• A significant reduction in Disabilities of the Arm, Shoulder, and Hand (DASH) scores (6.9%) indicated good functional recovery.
• Excellent cosmetic and functional results achieved at 18 months, with no web space contracture.

Conclusions:

• Acellular dermis serves as a valuable adjunct for wound coverage in hand surgery, especially for functionally critical areas.
• This technique facilitates definitive reconstruction by allowing adequate time for oncologic margin assessment.
• The use of acellular dermis promotes improved healing and prevents debilitating contractures in hand defects.