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CASE SERIES

Staged wound reconstruction utilizing regenerative dermal matrix followed by split-thickness skin grafting in the setting of local radiation: A case series with review of the literature

Emily S. Baruch1 ,  Kristina M. Crawford2 ,  Matthew R. Endara3*
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1 Lincoln Memorial University, Harrogate, Tennessee, United States of America
2 Plastic and Reconstructive Surgery, University of Florida, Gainesville, Florida, United States of America
3 Maury Regional Medical Center, Lincoln Memorial University, Plastic and Reconstructive Surgeon, Columbia, Tennessee, United States of America
ARNM 2024, 2(2), 3388 https://doi.org/10.36922/arnm.3388
Submitted: 9 April 2024 | Accepted: 31 May 2024 | Published: 20 June 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

The use of radiation for local control following tumor extirpation has improved outcomes across the spectrum of oncologic conditions. Reconstructive strategies that improve short-term healing rates and long-term results in these complicated wound healing environments are paramount to success. Regenerative dermal matrices (RDM) have emerged as viable options to improve reconstructive outcomes in the field of radiology. Here, we present a case series highlighting our algorithm of staged reconstruction using regenerative dermal matrix followed by split-thickness skin grafting to reconstruct skin deficits following excision of tumors either before or after radiation. A systematic review of the literature pertaining to irradiated wound closure and the application of dermal regenerative templates is presented to better understand its emerging role to manage these complex cases and impact future outcomes. Six patients underwent staged reconstruction using our algorithm, all of which went on to heal completely without additional procedures or evidence of skin breakdown in the short and long term. RDMs seem to improve the radioresistance of surgically reconstructed wounds following excision of cancer. The mechanism for this is likely related to the creation of additional tissue layers beyond those replaced with skin graft alone and should be the subject of future study.

Keywords
Integra
Radiation wounds
Reconstruction
Regenerative dermal matrix
Plastic surgery
Skin graft
Funding
None.
Conflict of interest
Emily S. Baruch and Kristina M. Crawford declare that they have no competing interests. Matthew R. Endara is a consultant for Integra.
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