Facial Reconstruction with Decellularized Fish Skin Avoiding Plastic Reconstruction with Sedation

Introduction: Facial defects resulting from Mohs micrographic surgery can be large requiring large reconstructive repairs with a plastic surgeon. These repairs usually require sedation which can pose a greater risk for the patient. Decellularized fish skin can be used to reduce the size of the defect allowing a smaller reconstruction or allow for second intention healing once a healthy granulation bed is obtained. This allows most reconstructive techniques to be performed in a clinic setting using local anesthesia. Smaller repairs can allow for favorable cosmetic outcomes and easier recovery for patients. We evaluated the use of decellularized fish skin in post Mohs reconstruction for facial defects that would normally be referred for plastic surgery.Methods:Skin cancer patients with facial post-surgical defects requiring plastic surgery were selected for application of decellularized fish skin. Wounds were evaluated weekly until a healthy wound bed was established. Wounds were then allowed to heal with second intention unless a smaller in office repair was indicated. Wound healing, dimensions, and patient satisfaction were evaluated at each visit.Results:Table 1 demonstrates patient data. The average wound size was 33.6cm2 (4.6- 115.0cm2) in 8 patients, requiring an average of 3 (1- 4 applications) applications of decellularized fish skin. Fifty percent of the wounds required an additional repair with an average of 4 months (2- 9 months) to heal. All patients expressed satisfaction with the healing process and end results. Figures 1- 8 illustrate sample case photographs.Discussion: Decellularized fish skin can be utilized as a repair option for post Mohs facial defects. Wounds can go on to heal with second intention or smaller repairs removing the need for sedation without sacrificing cosmetic results.References: