Management of severe hand wounds with integra® dermal regeneration template

Abstract

We report our experience with the use of Integra® for the management of severe traumatic wounds of the hand. Fifteen patients were treated with follow-up ranging from 10 to 37 months. Wounds were associated with an osseous and/or joint and/or tendon exposure. Following Integra® placement, patients were managed with dressings and subsequent split-thickness skin grafting an average of 26 days later. Integra® was successful in achieving durable, functional and aesthetic definitive coverage in 13 of 15 applications while allowing a satisfying pollicidigital prehension. Regarding our clinical experience, Integra® is an effective technique to deal with severe wounds of the hand with exposed tendon and/or bone and/or joint, even in the absence of paratenon or periosteum. This can potentially lessen the need for local rotational or free flap coverage and should be taken into consideration as a viable alternative in traumatic reconstruction of the hand.

Long-term outcome after use of an acellular collagen matrix in a finger degloving injury

“…In both cases, the disruption of both neurovascular bundles and dorsal vascular support led to necrosis of the distal phalanx [9]. Other authors have reported cases of burn injuries to the hands [10] and reconstruction of digital defects [7] that have been successfully managed with acellular dermal matrices (ACMs).…”

“…Applied to wound beds with adequate blood supply, such as the paratenon, and through the revascularization of the scaffold, it provides a new vascular layer. This makes it a useful therapeutic tool in situations where a flap cover would normally be required [7].…”

General Principles of Skin Cover and Flaps to the Elbow, Forearm, Wrist and Hand

“…Collagen Substitutes . The use of bovine collagen dermal substitutes is increasing and will become an important factor in wound healing in the future [ 9 ]. See the Chapter on Burns.…”

A Short Commentary about Efficacy of an Flowable Matrix in the Treatment of Diabetic Foot Ulcers

“…In patients with acute burns and in patients with chronic skin lesions, following severe injury in skin and peripheral nerves, a dermal substitute highly porous collagen scaffold has induced regeneration displacing the skin autografts in the treatment of skin lesions [11][12][13][14][15][16][17][18][19]. After severe trauma, in the adult mammal occurs a wound constriction and scar formation.…”