Treatment of chronic infected post-oncological wounds with a dermal matrix: two case studies

The reconstruction of complex wounds in patients with comorbidities in the lower extremities is a challenging problem for surgeons. Skin grafting is frequently used to cover large skin defects, but it has several limits, including unwanted outcomes resulting from scars, poor elasticity and limitations in joint movement due to contractures. Locoregional flaps, particularly in the lower limbs, have limited application due to the size of the defect. Tissue engineering of the skin has offered major improvements in the coverage of large defects. Dermal matrix can be applied in order to generate a new dermis that allows good re-epithelialisation or skin grafting at a later stage. The reconstruction of large lower limb defects is more complicated in the case of chronic wounds showing no tendency to heal due to chronic infection. For all surgeons, it is very important to prevent the formation of a biofilm or manage it when it is already established before undertaking surgical procedures that involve a dermal matrix. We report our reconstruction strategy of chronic infected neoplastic ulcers of the lower extremities with a dermal matrix and our postoperative dressing protocol.