Use of Bilayer Wound Matrix for Closure of Post-Mohs Surgery Defects of the Nose

There are over 5 million skin cancers reported in the United States annually. Among those, though not followed statistically, Mohs surgical resections for skin cancer on the nose are common. Obtaining consistent and cosmetically acceptable results for nasal reconstruction, following resection of nasal carcinomas, is more complex than anticipated. This is due to: 1) the paucity of available skin for remodeling, 2) the difficulty of obtaining an acceptable skin match through autograft, 3) the complex shape and anatomical function of the nose, and 4) the effect of the nose on the overall appearance of the face. Furthermore, the population requiring repair is commonly in the fourth through eighth decade of life with many having multiple chronic health issues that contribute to healing difficulties. This population seeks a simple, minimally-invasive, one-stage procedure with cosmetically acceptable results. Our brief experience with Bilayer Wound Matrix (IBWM, Integra LifeSciences) suggests this may be an excellent medium for addressing these issues.

Two patients are reported with significant nasal defects following Mohs surgical resection of cancers. Neither defect was into the nasal cavity. One patient, 48 yo male presented with a 2.5 x 1.5 cm x 3-4mm deep defect of the right alar lobule. Lower lateral cartilage was not exposed. The patient was deemed a suitable candidate for IBWM. The graft was placed under local anesthesia in the office setting. A second patient, 75 yo female with a 2.0 x 1.7 cm dorsal nasal defect over the center of the nose above the supra tip was given various options for repair and opted for an IBWM. Again, surgery was performed in the office setting under local anesthesia. In both cases a tie over bolster of petrolatum gauze and 5-0 Prolene fixed the graft. The tie over bolsters were removed between 5 and 7 days.  The silicone sheeting was removed about day 21 for both patients. Subsequent dressings were with colloidal bandages.

Both cases had spontaneous epithelialization, by day 48 (48 yo male) and day 29 (75 yo female). The covering was stable and cosmetically acceptable at time of complete epithelialization.

Closure of post-Mohs surgery nasal defects with IBWM represents a viable option and an advantage over alternative forms of surgical repair, such as skin flaps, skin grafts and healing by secondary intention., when considering cosmesis of the end result and patient satisfaction with the process.

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