Integra versus NovoSorb BTM for periocular reconstruction following Mohs micrographic surgery: Outcomes and an...

Dermal substitutes are increasingly being used for periocular reconstruction following Mohs micrographic surgery (MMS); however, no study has directly compared Integra® Dermal Regeneration Template and NovoSorb® Biodegradable Temporizing Matrix (BTM) in this anatomic region. We provide the first direct comparison of Integra and BTM for periocular reconstruction following MMS and propose an updated reconstructive algorithm incorporating findings on matrix selection and subunit-specific complication risk. A retrospective review was conducted of all patients who underwent periocular reconstruction with Integra or BTM following MMS between May 2019 and January 2026 by a single surgeon at a tertiary academic medical center. Patient demographics, defect characteristics, healing outcomes, and postoperative complications were recorded. Multivariable logistic regression was used to identify independent predictors of complications, additional surgical procedures, and revision surgery. A total of 128 patients were included (88 Integra and 40 BTM). Overall complication (44.3% vs. 20.0%; p=0.006) and ocular complication (37.5% vs. 15.0%; p=0.007) rates were significantly higher in the Integra group. Ectropion occurred in 28.4% of Integra patients versus 2.5% of BTM patients (p<0.001). On multivariable regression, Integra use was found to be independently associated with increased odds of ectropion (OR 14.84; p=0.014), additional surgery (OR 19.78; p<0.001), and revision surgery (OR 6.67; p=0.006). Lower eyelid involvement was the dominant independent predictor of any complication and any ocular complication. In this retrospective, non-randomized comparison, BTM was associated with significantly lower rates of ectropion, additional surgery, and revision surgery than Integra, and these associations persisted after adjustment for defect size and subunit involvement. Given the baseline imbalance between the groups, including larger defects treated with Integra, and the relatively short follow-up (particularly in the BTM cohort), these findings should be considered as hypothesis-generating and interpreted as an association rather than a definitive preference for one matrix over the other. Further prospective validation is warranted before broader clinical recommendations can be made regarding matrix selection, particularly for lower eyelid defects.