title: Improved patient-centered care with effective use of Integra® in dermatologic reconstructive surgery.
abstract: BACKGROUND
  The incidence of skin tumors is increasing among elderly patients, and the multi-morbidities which occur in the elderly are a great challenge for dermatologic surgeons. The currently required safety margins for different types of melanomas and non-melanoma skin cancers lead to extensive and profound wounds.
  
  
  OBJECTIVE
  To investigate the usefulness of a dermal substitute (Integra®) for routine use in surgery for dermatologic tumors.
  
  
  METHODS
  In this retrospective study 20 patients underwent sequential surgeries for skin cancer. Wound closures were performed using Integra® (single layer) and immediate split-thickness skin graft.
  
  
  RESULTS
  Twenty-two tumors (6 malignant melanomas, 10 squamous cell carcinomas, 2 pleomorphic sarcomas, 1 basal cell carcinoma, 2 Merkel cell carcinomas, and 1 trichoblastic carcinoma) were resected. The mean defect size was 41.4 cm(2) . All transplants were (65-100 %) vital; however, defects in the midface (cheek and infra-orbital area) often healed with esthetically disturbing, dense, pillow-like scars.
  
  
  CONCLUSIONS
  With the use of Integra®, the duration of hospitalization was decreased, patients with multi-morbidities were effectively treated, and functionally- and esthetically-satisfactory outcomes were achieved. On the basis of these observations, we discuss points of handling those patients who require rapid and effective surgery and undergo dermatologic surgery using dermal substitutes.
authors: Department of Dermatology, Saarland University Hospital, Homburg/Saar, Germany. cornelia.mueller@uks.eu
authors: Cornelia Sigrid Lissi
authors: CS
authors: Müller
authors: Claudia
authors: C
authors: Schiekofer
authors: Rebecca
authors: R
authors: Körner
authors: Claudia
authors: C
authors: Pföhler
authors: Thomas
authors: T
authors: Vogt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002809:Chondroitin Sulfates / Q000627:therapeutic use*; D003094:Collagen / Q000627:therapeutic use*; D062109:Dermatologic Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D058106:Wound Closure Techniques
chemical_list: C114835:integra artificial skin; D002809:Chondroitin Sulfates; D003094:Collagen