Early intitiation of radiation due to the use of the artificial dermis (Integra®) and subsequent topical negative pressure in a merkel cell carcinoma patient

Background: The aim of this report is to emphasize the possibility of an early initiation of radiation after the tumor excision and before the complete wound healing through the use of a dermal skin substitute.

Main Observations: A 75-year old patient with a merkel call carcinoma on the right forearm, first diagnosed in September 2013, underwent a sentinel lymph node biopsy with a 2 cm radial re-excision margin. To accelerate the healing progress and enable the early initiation of the radiation an artificial dermis (Integra®) was used in the reconstruction of the surgical defect. With the application of Integra®, a vacuum assisted closure (VAC) was also applied to accelerate the integration and neovascularisation. After VAC removal two weeks later the radiation could be intiated.

Conclusions: Although dermal substitutes have been used for years in oncologic patients, this is the first report of a therapeutic combination of an artificial dermis with a subsequent radiotherapy before skin-grafting and complete wound healing. This combination offers the patient a stable defect reconstruction, the simplification of the wound care and the early beginning of radiotherapy reducing the rates of recurrence as well as the local and regional metastatic behaviour.