Utilizing Integra for Reconstruction of Facial Defects after Mohs Micrographic Surgery

Introduction

A high concentration of ultraviolet (UV) light exposure in the facial region contributes to the development of cutaneous malignancies. The upper face is referred to as the “sun terrace” because of the way in which the skin is angled toward the sun (1). Mohs micrographic surgery (MMS) is the gold standard surgical technique for excising non-melanoma skin cancers (NMSC) from the face, because of its ability to histologically clear margins and preserve healthy tissue (2). Unfortunately, obtaining clear margins with Mohs surgery can still cause substantial soft tissue defects and lead to significant functional, cosmetic, and psychological sequelae (3).

  Traditional options for soft tissue reconstruction of the face include primary closure, skin grafts, locoregional flaps (LRFs), distant skin flaps, and free tissue transfer. The reconstructive ladder helps guide the decision-making process, primarily employing the simplest wound closure option first and then graduating to more complex procedures. Following primary closure, Integra Bilayer Wound Matrix (Integra®, Plainsboro, NJ) has more recently proven itself to be an addition to the reconstructive ladder due to its ease of application and ability to achieve satisfactory outcomes in both single and dual stage reconstruction of challenging areas on the face (4-7).