Use of Porcine Xenografts on Partial-Thickness Vermilion Border and Mucosal Lower Lip Mohs Defects

I read with interest the article by Pickert and

Nemeth.1 Preservation of function and optimiza-

tion of cosmesis are the primary objectives to

consider after Mohs micrographic surgery for

extirpation of cutaneous malignancies on the lip.

To the degree that these objectives can be predict-

ably met, one may allow surgical defects on the lip

to heal by second intention. This reconstructive

option may be simpler than other repair options,

such as wedge closures or mucosal advancement

flaps, because of the lower risk of morbidity from

hematoma, flap necrosis, suture reaction, and

dehiscence. Second intention healing also facilitates

monitoring for tumor recurrence, although this

“simpler” option mandates equivalent cerebral

input for success. Among the factors that should

be carefully evaluated when considering second-

intention healing as an option for surgical defects

on the lip are depth and breadth of the wound,

patient compliance, bleeding tendency (intrinsic

and iatrogenic), and optimum wound care man-

agement.

Previous reports have described the successful use

of healing by second intention for lip defects and

have provided insight regarding the proper selec-

tion of patients and surgical defects. Gloster

suggested that optimal defects be superficial (no

deeper than the superficial orbicularis oris), involve

no more than 2 mm of the cutaneous lip, and be

no more than 2.5 cm in diameter. In the 13

patients, time to re-epithelialization ranged from 3

to 5 weeks.2 In another report, Leonard and

Hanke3 described effective and satisfactory second-

intention healingof partial-thickness lip defects up

to 3 cm in diameter with minimal involvement of

the cutaneous lip; re-epithelialization was achieved

in an average of 25 days.

The authors of the current report describe the use

of porcine xenografts to facilitate second-intention

wound healing of lip defects from Mohs micro-

graphic surgery and provide a contrast between

practicality and science. On the one hand, this

repair option appears to be worth consideration by

Mohs surgeons for lip defects that would probably

heal well by second intention given the benefits of

simplified wound care, a moist and protective bar-

rier, less pain, and low cost. Similar benefits have

been described previously, although not for lip

defects.4 Time to re-epithelialization appears to be

within the same range as other reports without the

use of porcine xenografts. On the other hand, the

science underlying the effects of these biologic

dressings is nearly negligible, although worthy of

study. In the age of rising healthcare costs and

evidence-based medicine, a simple but well-

designed study may demonstrate that a $25 piece

of pig skin can increase patient satisfaction,

decrease pain, and accelerate wound healing.

References

1. Pickert AJ, Nemeth SA. Use of porcine xenografts on partial-

thickness vermilion border and mucosal lower lip mohs defects.

Dermatol Surg 2013;39:948–50.

2. Gloster HM. The use of second-intention healing for partial-

thickness Mohs defects involving the vermilion and/or mucosal

surfaces of the lip. J Am Acad Dermatol 2002;47:893–7.

3. Leonard AL, Hanke CW. Second intention healing for

intermediate and large postsurgical defects of the lip. J Am Acad

Dermatol 2007;57:832–5.

4. Davis DA, Arpey CJ. Porcine heterographs in dermatologic

surgery and reconstruction. Dermatol Surg 2000;26:76–80.

CHRISTIAN L. BAUM, MS, MD

Mayo Clinic

Rochester, Minnesota

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