Ann: Annual Report 2023, page-17

International centre for Scientific Cooperation " Science and Education" - Scientific forum

Penza - Russia - 27/8/2023

COMPLEX DEFECTS OF THE SCALP: APPLICATION OF A BIODEGRADABLE MATRIX
https://naukaip.ru/wp-content/uploads/2023/08/MK-1790.pdf#page=147

The abstract is written in English, however the remainder is written in Russian. I've had the help of google translate do the rest(not perfect).

Abstract: Dermal matrices have become a potential option for complex wound treatment. The biodegradable
temporary matrix of PolyNovo or NovoSorb has shown promise in the treatment of partial and full-layer
wounds. Here we discuss the successful use of this product in the treatment of a scalp defect complicated by
bone exposure after extensive local excision of desmoplastic melanoma of the scalp.
Key words: Dermal matrices, desmoplastic carcinoma, microsurgery

Introduction: Desmoplastic melanoma (DM) is a rare histological variant of spindle cell melanoma first described by Conley et al in 1971. It accounts for less than 4% of cutaneous melanoma cases and is associated with high rates of local recurrence (up to 40%), but relatively low rates of nodal metastases. It is associated with chronic exposure to UV radiation, resulting in 51% of DM occurring in the head and neck region and 30% in the extremities. The majority of patients are older men (male to female ratio: 2:1; mean age at diagnosis: 66 years).

Main Part:
DM can occur de novo or in association with other melanoma subtypes. It usually appears as a discolored nodule or skin plaque that may resemble a scar and is therefore susceptible to late or misdiagnosis even by light microscopy.[1],[2] Due to the high rate of local recurrence, ensuring adequate surgical margins is critical. . Treatment includes wide local excision (with margins of at least 2 cm) and adjuvant radiation therapy. This approach can result in significant defects and requires careful reconstructive planning to achieve optimal functional and esthetic results. Naked In the neck and neck, these surgical margins can lead to complex reconstruction. Direct closure may not be possible, and skin grafts result in aesthetic defects, skin instability, or failure to vascularize the exposed skull. Large local flaps or microsurgical reconstruction may be required due to increased physiological demands and the potential need for skin grafting of a secondary defect.[3]

One of the articles describes a case of desmoplastic carcinoma: in connection with the area of exposure of the calvarium, transposition of the scalp flap with skin grafting of the secondary defect was again discussed, as well as an additional option of BTM. After discussing this product, its novel use, and the possibility of reconstructive failure, the patient chose this option. During the operation there were large areas of exposed bone, but approximately 50% had thin granulation tissue. The wound was cleaned, the exposed bone was filed down to the bleeding tissue and the drug was applied. He was fixed with non-absorbable sutures and bandaged. The reconstructed wound was treated postoperatively using the same protocol as wide local excision.

After reviewing the patient 5 weeks postoperatively, the outer silicone layer was removed and the neodermis showed satisfactory vascularization. Epithelialization progressed rapidly and split-thickness skin grafting was not required. 10 weeks after reconstruction, epithelialization was shown to have progressed, and the patient began postoperative radiation therapy , which she tolerated well.[4]

Over the past few decades, dermal substitutes have emerged as a potential solution for comprehensive wound care. The PolyNovo NovoSorb biodegradable temporary matrix (BTM), originally developed to facilitate the treatment of burns, is one example of this. BTM is a leather substitute derived from open cell polyurethane foam. Polyurethane foam is a framework that allows for the ingrowth of granulation tissue, which then decomposes as a result of hydrolysis, leaving behind neodermis. The foam does not contain substrates for bacterial metabolism and is believed to reduce the risk of infection compared to collagen-containing dermal matrices. A silicone layer covers the foam to reduce drying, which is removed once tissue ingrowth is adequate, allowing either skin grafting, or secondary epithelialization. We describe the use of this product to treat a defect following excision of DM of the scalp that has not been previously described.

Scalp defects occur for a variety of reasons and can be complicated by bone exposure or fracture. Although a variety of reconstruction options are often available, they must be individualized based on the patient's ability to tolerate anesthesia, surgery, donor shortages, risks, and postoperative management.

This was associated with a high risk of complications from microsurgical reconstruction, and a local transposition flap would require skin grafting of a secondary hairline defect. Split skin grafting alone might not be effective on exposed bone and would be vulnerable to destruction after radiation therapy.[5]

Thus, the use of BTM minimized the time of anesthesia, surgery and hospital stay, and also avoided the need for a donor site. This also led to a very acceptable aesthetic result compared to what is expected from other options.

Please note, Russia is not one of the Market entry options currently being evaluated.

Once again the product is doing the work itself and attracting interest from all over the world.