# The Use of Esterified Hyaluronic Acid Matrix in the Setting of a Large Marjolin Ulcer Excision and Reconstruction: A Case Report

## TL;DR

This case report describes the successful use of an esterified hyaluronic acid matrix in reconstructing a large Marjolin ulcer after surgical removal.

## Contribution

The novel application of eHAM in multi-stage reconstruction of a large Marjolin ulcer is highlighted.

## Key findings

- eHAM was used to improve wound healing and graft recipient site strength in a large MU case.
- The multi-stage approach with eHAM facilitated successful reconstruction after radical excision of the ulcer.

## Abstract

Marjolin ulcers (MUs) are a rare complication of chronically inflamed wounds and scars, with the most common histology being squamous cell carcinoma. MUs have high rates of metastasis and recurrence and a poor prognosis. Due to their aggressive nature, such cutaneous growths require radical excision and subsequent grafting. In large MUs, the use of a multi-stage approach to reconstruction provides better wound healing and graft recipient sites. An additional modality to further the results of the reconstructive approach includes the use of an esterified hyaluronic acid matrix (eHAM) prior to the placement of split-thickness skin grafts. eHAM, frequently used in wounds and deep burns, provides a scaffold for granulation tissue formation thus furthering the strength of graft recipient sites. We present a case of a large MU at the site of a long-standing burn scar that was excised with clear margins and reconstructed with stage skin grafting using eHAM.