A complex multisubunit repair using three different flaps J. Boggs, J. Ralph, C. O’Grady and R. Barry St James’ Hospital, Dublin, Ireland Mohs micrographic excision of nonmelanoma skin cancers resulting in composite defects, including two or more facial subunits, involving the medial cheek, ala, apical lip and upper cutaneous lip pose, can result in challenging surgical defects to reconstruct. Key considerations include proper delineation of the affected units/subunits, restoring volume to the ala and recreation of the natural concavities of the alar crease and nasolabial fold. In addition, care must be taken in relation to free-margin positions of the ala and upper vermillion lip. There are many options available to the surgeon, but consideration of patient comorbidity and expectations should be accounted for. Reconstructive options include locoregional skin flaps, complex multistage interpolated flaps or skin grafting. Given the complex topography of this area, when faced with reconstruction of defects involving the alar–facial sulcus and upper cutaneous lip, multiple flaps are often necessary to recreate its natural appearance and symmetry, while also preserving the alar crease and melolabial sulcus. We highlight the merits of a complex subunit repair using a fat hinge flap, a 180 twisted island pedicle flap (IPF) and a V to Y flap. A 55year-old presented with an 18 9 13 mm nodular and infiltrating basal cell carcinoma involving the right nasal ala and apical lip. Three stages of Mohs micrographic surgery led to tumour-free margins and resulted in a surgical defect measuring 28 9 23 mm. The defect was complex involving the right medial cheek, ala, apical lip and upper cutaneous lip. An incision was made along the lateral wound margin, and a fat hinge flap was elevated and placed into the deep apical lip defect and secured. An IPF flap from the right nasal sidewall was created by the entire flap being incised through the skin while maintaining the integrity of underlying subcutaneous fat, muscle and vasculature. The flap was then transposed over the intervening tissue and twisted 180 to recreate the right alar base. The secondary defect on the right nasal sidewall was closed primarily. A V to Y flap was elevated from the lateral chin extending onto the medial cheek to close the residual defect. We have found these flaps to be a useful reconstruction for large deep surgical defects on the medial cheek, ala, apical lip and upper cutaneous lip. It results in an aesthetically acceptable surgical outcome and is a one-stage procedure, which may be preferable for some patients. DS12 Replacing the need for skin grafting in small surgical excision wounds L. Hook, D. Barnes, J. Sullivan, A. Reid, R. Tousis, C. Morgan, A. Belgi, S. Booth and B. Dheansa Smart Matrix Limited, London, UK; St Andrew’s Burns and Plastics Centre, Broomfield Hospital, Chelmsford, UK; Department of Plastic Surgery and Burns Wythenshawe Hospital, Manchester, UK; Poole General Hospital, Poole, UK; and McIndoe Burn Centre Queen Victoria Hospital, East Grinstead, UK Smart Matrix is a novel fibrin/alginate dermal replacement scaffold developed for the treatment of full-thickness wounds without the need for a skin graft. The safety and performance of Smart Matrix in the treatment of surgical excision wounds arising from the excision of nonmelanoma skin cancer (NMSC) is currently being assessed in an ongoing clinical investigation. Recruitment into the trial is complete with 32 patients being treated at four clinical centres. The average age of the patients is 75 years (range 54–90) and all lesions have been on either the lower leg or scalp. The average excision wound size is 10 5 cm (range 3 7–25 5). Patients are assessed for safety parameters, such as infection and seroma, and the need for a ‘rescue’ skin graft. Performance parameters include time to healing and scar quality using Patient and Observer Scar Assessment Scale and Vancouver Scar Scale scores. Patients are followed-up for 12 months. Surgeon assessment of the device is also recorded. The trial is funded by Smart Matrix Limited. To date, 25 patients have completed the study. All wounds have healed with minimal complications: infection, seroma and haematoma rates are within expected levels for this type of surgery. Importantly, no patients have required a skin graft or any further surgical intervention. Healed wounds show a favourable scar outcome, in particular with reference to contour and contraction. Surgeons report that the device is simple to use and no specialist training is required. Patient satisfaction is high, with the primary advantages being reported as not having to have a donor site wound and the good cosmetic outcome of the scar. Several patients who have presented with second lesions during the study have asked to be treated with Smart Matrix again rather than have a skin graft. Smart Matrix has a good safety and performance profile in the treatment of NMSC excision wounds without the use of a skin graft. Although healing times are slower than would be expected for a skin-grafted wound, this has not been associated with any increase in wound complications, such as infections, or compromise on scar quality. In fact, wounds treated with Smart Matrix result in a good cosmetic and functional outcome, which in many cases is better than would be expected for a skin-grafted wound. Smart Matrix has the potential to offer an alternative to skin grafting for surgical excision wounds with consequent benefits to the patient of avoiding a donor site wound and its associated morbidity. It may also have application in small traumatic skin injuries or burns and in nonspecialist settings.