Acellular Wound Matrix for Mohs Surgical Reconstruction: Foot Case Series
Summary: This retrospective case series reviews 29 patients treated with an acellular wound matrix (Dermal Regeneration Template, DRT) immediately after Mohs micrographic surgery for foot skin lesions, primarily melanoma (65.5%), from 2018-2023 at UT Southwestern. Average wound size was 4.4 cm × 4.0 cm × 0.8 cm, with 75.9% achieving complete epithelialization in 139 days via secondary intention or adjunct split-thickness skin grafting (STSG) after 4-6 weeks. Complications occurred in 27.6% (infections and recurrences most common), higher than typical Mohs rates due to foot anatomy, but all patients returned to pre-op function without revisions. The approach preserved weight-bearing capacity, highlighting DRT’s role in complex dermatologic foot reconstruction amid smaller margins to maintain mobility.
Key Highlights:
- Average patient age 61.3 years; 58.6% female; 34.5% lesions on toes, emphasizing high-risk sites for melanoma with poor prognosis.
- DRT sutured post-resection, followed by offloading (NPWT/splint) and STSG in 91% of adjunct procedures, promoting neodermis formation.
- Healing success in 22 patients (75.9%), with average 140.8 days to full activity; no vascular assessments, but outcomes comparable to diabetic foot literature.
- Complications: 13.8% infections, 13.8% recurrences, 3.4% graft failure; foot-specific challenges like folds and pressure noted, requiring expert technique.
- Cost analysis: ~$39,362 self-pay per patient (visits, surgeries, NPWT); supports DRT as viable for functional preservation in Mohs foot cases.
Keywords: acellular wound matrix, Mohs reconstruction, foot melanoma, DRT, dermatologic surgery, Elizabeth A Ansert, James F Thornton, Amy Du