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Engineered Skin Substitutes in Dermatologic Surgery: A Systematic Review.

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Artificial skin substitutes show excellent outcomes in Mohs micrographic surgery (MMS) for cutaneous malignancy. Further prospective studies are needed to compare different skin substitutes and controls.

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Area of Science:

  • Dermatology
  • Surgical Oncology
  • Regenerative Medicine

Background:

  • Artificial skin substitutes offer a flexible alternative to autografting in Mohs micrographic surgery (MMS).
  • The clinical characteristics and outcomes of skin substitutes in MMS are not well-defined.
  • This study aims to summarize existing clinical data on skin substitutes used in MMS for cutaneous malignancy.

Purpose of the Study:

  • To systematically review and synthesize clinical data on the use of artificial skin substitutes in Mohs micrographic surgery (MMS).
  • To evaluate the outcomes and complications associated with different types of skin substitutes in treating cutaneous malignancies.

Main Methods:

  • A comprehensive literature search was performed across MEDLINE, Embase, and Web of Science.
  • Included studies reported original data on outcomes following skin substitute use in MMS for cutaneous malignancy.
  • Data synthesis involved weighted averages, and bias was assessed using the Oxford CEBM Levels of Evidence.

Main Results:

  • Out of 1,007 articles, 40 met the inclusion criteria, encompassing 898 patients.
  • Xenografts were the most frequently used type of skin substitute.
  • Overall outcomes were excellent across all skin substitutes, with minor, correctable complications reported in a small patient subset. Semi-synthetic and xenografts demonstrated affordability.

Conclusions:

  • Artificial skin substitutes are highly effective and demonstrate significant potential in Mohs micrographic surgery.
  • Current evidence primarily stems from small, retrospective studies, highlighting a need for comparative and prospective research.
  • Further investigation is recommended to compare different skin substitutes and establish their efficacy against controls.