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Biologic Agents in Plastic Surgery
This is my fourth opportunity to write for Thieme Seminars on Reconstruction after Skin Cancer Resection. The entire issue is devoted to the use of biologic agents in wound healing, and I am excited to provide additional perspective on this topic.
During my general surgery residency, over 30 years ago, I would frequently call home to talk to my father who at that time was a career NASA physician astronaut and was widely regarded as a clear thinker across many medical specialties. I enthusiastically discussed most of my surgical cases with my father and his response was often less enthusiastic. At the time, he would always consider nonoperative care with the phrase that “the need to go to surgery is often considered a failure from other treatment methods.” I think it has taken close to 20 years for me to realize the sageness of this advice and although the maximum “a chance to cut is a chance to cure” holds true in many cases, the need for massive soft tissue cancer resection in involved surgical reconstructions can often be a system's failure of medical care. These failures include overall population health, unequal access to care, and failure to consider nonsurgical treatment modalities.
However, there is always going to be an ongoing need for surgical care in skin cancer reconstruction, and the current biologic agents may well be the harbinger of remarkable products for this generation; products that allow the body to heal itself without extensive surgery and its accompanying morbidity.
Currently, when cost, patient safety, and donor site morbidity are all considered, biologics can provide far superior results in few cases and equal results in many cases. There are, however, many current limitations in their use, and perhaps these should just be considered manageable challenges for this generation of surgeons.
Article published online:
13 June 2022
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