The Use of Novosorb Biodegradable Temporizing Matrix for Reconstruction in Head and Neck Cancer: A Simple Answer to a Complex Problem

Abstract

Background: Skin cancer defects in the head and neck can pose a reconstructive challenge. We aimed to evaluate our experience of Novosorb biodegradable temporizing matrix (BTM) in reconstructing complex defects in the head and neck region.

Methods: Assessment of all patients where BTM was used for head and neck skin cancer reconstruction was undertaken at our facility. This included tumor type; defect size; second-stage reconstruction (SSR) method; and complications, including failure.

Results: Fifty-four patients were identified with 63 lesions reconstructed with BTM. The mean age was 79. Histology was squamous/basosquamous carcinoma in 40 cases (63%), basal cell carcinoma in 15 cases (24%), and melanoma in 3 cases (5%). The anatomical region reconstructed was the scalp in 46 cases (73%) and the nose in 13 cases (21%). Mean maximum defect diameter was 67 mm. In 27 cases (43%), a previous wide local excision demonstrated an involved or close (<1 mm) margin. BTM was applied to burred bone in 24 of these cases (89%). SSR occurred via use of split-thickness skin graft (68%), full-thickness skin graft (14%), or via secondary intention (17%). One (1%) patient died before SSR, unrelated to BTM. SSR was carried out at a mean of 51 days. Five areas of 63 (8%) experienced a failure to fully heal, identified as due to recurrent or residual disease, causing wound breakdown. No significant infections were observed.

Conclusions: BTM offers a safe, reliable option for complex head and neck cancer reconstruction, particularly in patients unable to undergo more complex procedures.

Fig. 1.

Steps in tumor resection and BTM application. A, Right recurrent ear SCC with 1 cm resection margin. B, Resection complete with underlying exposed mastoid. C, Mastoid postburring with punctate bleeding. D, Placement of BTM into the defect with oropharyngeal airway placed in external auditory meatus to act as a stent. E, Integrated BTM 6 weeks postoperative, immediately pre-SSG. F, One-week post-SSR with fully healed SSG.

Fig. 2.

Summary of the SSR method.

Fig. 3.

Case 1. A, Large SCC on the scalp, preoperative. B, Scalp 1 week after SSR.

Fig. 4.

Case 2. A, Micronodular BCC to nasal tip and dorsum. B, Defect following Mohs excision of lesion with exposed cartilage. C, Delaminated BTM showing granulation tissue 45 days postapplication and immediately pre-SSR. D, Healed SSG 28 days following SSR procedure.

Fig. 5.

Case 3. A, Preoperative markings of glabella SCC. B, Resultant defect following Mohs surgery. C, BTM in situ 56 days after inset. D, Healed SSG 3 months after application as SSR.