Investigation of oral bromelain supplementation on the healing of skin flap reconstruction after Mohs micrographic surgery (MMS) for non-melanoma skin cancers (NMSCs).

Abstract

Introduction Non-melanoma skin cancers (NMSCs) are the most common malignancies and Mohs micrographic surgery (MMS) with flap reconstruction is the treatment of choice. This study aims to investigate the effect of bromelain on the healing of skin flaps following MMS for NMSCs.Methods In a single-center, parallel-group, single-blinded randomized clinical trial, 60 patients with NMSC who underwent MMS and flap reconstruction were assigned (1:1) to either an intervention group receiving bromelain (1500 mg/day, Rataheal™) for 15 days postoperatively or a control group receiving standard care alone. The primary outcome was time to suture removal; the early wound healing score (EWHS) was recorded supportively. Secondary outcomes included pain, inflammation, keloid/scar formation, cosmetic satisfaction, and traction quality.Results Baseline characteristics (age: 69.2 ± 13.5 years; 71.7% male; flap size: 116.1 ± 7.0 mm2) were analyzed. Bromelain significantly shortened time to suture removal compared with controls (2.6 days, 95% CI: 0.74-4.11; p = 0.006). The EWHS was also significantly improved at the day 7 (7.2 vs. 5, p < 0.001) and day 14 (8.56 vs. 7.3, p = 0.014) of follow up. Other outcomes, including inflammation, pain, and cosmetic satisfaction, showed non-significant trends favoring bromelain. No major complications were reported.Conclusion Bromelain supplementation is associated with earlier postoperative wound healing of skin flaps following MMS for NMSC, leading to 2.6 days earlier suture removal plus improvement in the EWHS without adverse effects. Our findings support the potential of bromelain as a safe and effective adjunct therapy for reconstructive skin cancer surgery.Trial registration Iranian Registry of Clinical Trials (IRCT20240903062943N1|| https://irct.behdasht.gov.ir/trial/79056 ), 2024.10.28, enrollment started after registration.