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Page 10 of 11 Hicks et al. Plast Aesthet Res 2022;9:2 https://dx.doi.org/10.20517/2347-9264.2021.65

Skin substitutes may be utilized in various capacities, depending on the molecular composition and physical
properties of a particular product [14,15] . Commonly described uses include the utilization of these products in
the management of burns and chronic wounds, including chronic venous ulcers, diabetic foot ulcers, and
pressure ulcers. One other application that is particularly relevant to the topic of skin and composite grafts
is the utilization of a dermal substrate during two-stage skin cancer resection and reconstruction. A recent
[16]
study evaluated the use of Hyalomatrix in 45 medically fragile patients with non-melanoma skin cancer .
These patients underwent excision of their cancer and application of Hyalomatrix in the first stage, followed
by application of skin graft or healing by secondary intention (if patient preference or patient found to be
unstable for further surgery). The use of the matrix induces neodermis formation with the goal of
optimizing skin graft take. Matrix was left in place for a mean duration of 19 days, and subsequent skin graft
placement demonstrated 95%-100% take. Of note, the reepithelialization time was relatively similar with and
without skin grafting, taking 31 days vs. 46 days, respectively. However, patient satisfaction scores were
[16]
significantly higher following skin graft placement .

As the development of these products continues to advance, there will be increased potential for their
utilization in the management of wounds. Therefore, it is important that clinicians stay abreast of these
advances and consider the incorporation of these products into their treatment algorithms when
appropriate.

CONCLUSIONS
Split-thickness skin grafts, full-thickness skin grafts, and composite grafts have many uses in facial
reconstruction, particularly in patients who wish to avoid a more extensive procedure. Thoughtful surgical
planning and meticulous technique are equally important in achieving optimal outcomes. An honest and
thorough discussion of all surgical options and anticipated results should be conducted with patients prior
to undergoing reconstructive procedures.

DECLARATIONS
Authors’ contributions
Made substantial contributions to researching and reviewing publications and compiling manuscript:
Hicks K
Made substantial contributions through provision of resources, organization of topic, and guidance
throughout writing: Thomas JR

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
Both authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Figures are obtained copyright permission from Elsevier. The authors state that the photos to be identified
don’t need to be obtained consent from patients.