Healing of Difficult Mohs Surgical Scalp Wounds with Exposed Bone using Decellularized Fish Skin Grafts

Introduction: Due to the inflexibility of scalp skin, Mohs Micrographic Surgical resection of skin cancers of the scalp can create difficult wounds due to exposure of the bone of the calvarium. Large wounds in scalp skin can limit the feasibility of flap reconstruction. Skin grafts are at high risk of failure when applied directly to bone. Even if successful, skin grafting can prevent the contracting of a wound as it heals leaving a large area of permanent alopecia resulting in poor cosmetic outcomes. We report the utility of decellularized fish skin xenograft for effective coverage of wounds with exposed bone and improved appearance of the final cosmetic outcome in wounds of hair-bearing skin.Methods:our cases of wounds created by Mohs Micrographic surgical excision of non-melanoma skin cancers of the scalp and forehead larger than 14cm2 were treated with the application of applied decellularized fish skin grafts.Results:Table 1 shows patient data. All wounds extended to the calvarium and ranged from 14.35 cm2 to 90.24 cm2. All wounds healed without complication and exhibited an average contracture of 57% (53-65%) to form smaller scars.Discussion: Decellularized fish skin grafts are effective in the management of scalp wounds with excellent formation of granulation tissue for coverage of bone. Wounds exhibited minimal inflammation and pain and also showed beneficial contracture resulting in cosmetically acceptable healed wounds with minimal alopecia.References: