Effective Management of a Non-healing Wound Post-Mohs Surgery using a Novel Self-assembling Peptide-based Advanced Wound Dressing

Repair of lower extremity wounds after Mohs micrographic surgery can be challenging due to a high propensity for complications and a painful, protracted healing course. Among the few options that have been investigated for their management include the use of partial- or full-thickness skin grafts and flaps.[1]

This case examined the use of a novel and proprietary self-assembling peptide-based product called, AC5 Advanced Wound System[2] (“AC5”), to treat a non-healing surgical wound persisting two months post-Mohs surgery. A 51-year-old male patient presented with a non-healing surgical wound of the pre-tibial, right lower leg. The patient underwent Mohs surgery for squamous cell carcinoma nine weeks prior to presenting to this clinic.

The patient has a history of chronic deep vein thrombosis causing a right pulmonary artery chronic thrombus and idiopathic mediastinal fibrosis, as well as hypertension and dyspnea. Previous wound-care treatment included use of various topical antibiotics and non-adhesive pads. Upon admission, the wound had a moderate amount of slough and measured 2.6 cm2. During the following week, treatment with AC5 was initiated immediately after excisional debridement.

The wound was dressed with Xeroform and Unna boot compression was provided. This regimen was repeated weekly for a total of four applications. During the course of the treatment, granulation tissue increased and the wound surface area progressively decreased 90% by the final application. The wound had completely healed by the final follow-up visit at week six.

Concomitant use of excisional debridement and treatment with AC5 markedly accelerated healing of this stalled wound, which had failed two months of standard therapy. The effect of AC5 may be attributed to the contiguous barrier it creates along the wound surface after debridement, in addition to its ability to promote cell adhesion, migration, and proliferation, which are essential for wound healing.