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Indications and functional outcome of the use of integra® dermal regeneration template for the management of traumatic soft tissue defects on dorsal hand, fingers and thumb

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Abstract

Introduction

Few studies have been conducted to explore the utility of the Integra® dermal regeneration template (IDRT) combined with a delayed split-thickness skin graft (STSG) for reconstructing complex dorsal hand, digit, and thumb injuries. This study reports the indications and outcomes for 14 patients treated with this technique via a two-stage process.

Materials and methods

We retrospectively reviewed all patients treated by IDRT combined with STSG from May 2015 to October 2018. The inclusion criterion was traumatic or post-infectious soft tissue defects (STDs) of the dorsal hand, fingers, and thumb, not suitable for direct wound closure and requiring local, pedicle, or free flap reconstruction. After debridement, a two-stage procedure was applied, namely IDRT followed by STSG. Indications, functional outcomes, aesthetic results, complications, patient satisfaction, and the STSG take rate were evaluated over a 36-month follow-up using standardised instruments.

Results

A total of 14 patients with 15 reconstructions (average age = 48 years) were included. The dominant hand was involved in 50% of cases. Dorsal STDs involved the hand, fingers, thumb, and hand and thumb in 7, 3, 2 and 2 cases, respectively. The mean STD size was 35 cm2 (range: 3–150 cm2). The wound was associated with exposed tendons (without peritenon), bone (without periosteum), and joints (without a capsule) in eight cases (57%). The IDRT/STSG take rate was 97%. The average Vancouver Scar Scale score was 2 (1–4).

Conclusion

The 36-month follow-up demonstrated that IDRT is a safe and reliable technique that can be considered a viable alternative to flap reconstruction for the management of traumatic STDs in selected patients. The aesthetic outcomes are acceptable, functional recovery of the fingers is excellent, patient satisfaction is very high and the rate of complications is very low.

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References

  1. Burke JF, Yannas IV, Quinby WC Jr, Bondoc CC, Jung WK (1981) Successful use of a physiologically acceptable artificial skin in the treatment of extensive burn injury. Ann Surg 194(4):413–428. https://doi.org/10.1097/00000658-198110000-00005

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Herlin C, Louhaem D, Bigorre M, Dimeglio A, Captier G (2007) Use of Integra in a paediatric upper extremity degloving injury. J Hand SurgEur 32(2):179–184. https://doi.org/10.1016/J.JHSB.2006.11.013

    Article  CAS  Google Scholar 

  3. Graham GP, Helmer SD, Haan JM, Khandelwal A (2013) The use of Integra® dermal regeneration template in the reconstruction of traumatic degloving injuries. J Burn Care Res 34(2):261–266. https://doi.org/10.1097/BCR.0b013e3182853eaf

    Article  PubMed  Google Scholar 

  4. Son JH, Bafus B, Khandelwal A, Chepla KJ (2018) Reconstruction of a circumferential upper extremity soft tissue defect with a dermal regeneration template and skin grafting. Tech Hand Up ExtremSurg 22(1):31–33. https://doi.org/10.1097/BTH.0000000000000185

    Article  Google Scholar 

  5. Baryza MJ, Baryza GA (1995) Thevancouver scar scale: an administration tool and its interrater reliability. J Burn Care Rehabil 16(5):535–538. https://doi.org/10.1097/00004630-199509000-00013

    Article  CAS  PubMed  Google Scholar 

  6. Campbell DA, Kay SP (1996) The Hand Injury Severity Scoring System. J Hand Surg Br 21(3):295–298. https://doi.org/10.1016/s0266-7681(05)80187-1

    Article  CAS  PubMed  Google Scholar 

  7. Valerio IL, Masters Z, Seavay JG, Balazs GC, Ipsen D, Tintle SM (2016) Use of a dermal regeneration template wound dressing in the treatment of combat-related upper extremity soft tissue injuries. J Hand Surg Am 41(12):453–460. https://doi.org/10.1016/j.jhsa.2016.08.015

    Article  Google Scholar 

  8. Carothers JT, Brigman BE, Lawson RD, Rizzo M (2005) Stacking of a dermal regeneration template for reconstruction of a soft-tissue defect after tumor excision from the palm of the hand: a case report. J Hand Surg Am 30(6):1322–1326. https://doi.org/10.1016/j.jhsa.2005.08.001

    Article  PubMed  Google Scholar 

  9. Murray RC, Gordin EA, Saigal K, Leventhal D, Krein H, Heffelfinger RN (2011) Reconstruction of the radial forearm free flap donor site using integra artificial dermis. Microsurgery 31(2):104–108. https://doi.org/10.1002/micr.20833

    Article  PubMed  Google Scholar 

  10. Ellis CV, Kulber DA (2012) Acellular dermal matrices in hand reconstruction. PlastReconstrSurg 130(5 Suppl 2):256S–S269. https://doi.org/10.1097/PRS.0b013e318265a5cf

    Article  CAS  Google Scholar 

  11. Weigert R, Choughri H, Casoli V (2011) Management of severe hand wounds with Integra® dermal regeneration template. J Hand SurgEur 36(3):185–193. https://doi.org/10.1177/1753193410387329

    Article  CAS  Google Scholar 

  12. Moiemen NS, Vlachou E, Staiano JJ, Thawy Y, Frame JD (2006) Reconstructive surgery with Integra dermal regeneration template: histologic study, clinical evaluation, and current practice. PlastReconstrSurg 117(7 Suppl):160S–174S. https://doi.org/10.1097/01.prs.0000222609.40461.68

    Article  CAS  Google Scholar 

  13. Arner M, Möller K (1994) Morbidity of the pedicled groin flap. A retrospective study of 44 cases. J PlastReconstr 28(2):143–146. https://doi.org/10.3109/02844319409071192

    Article  CAS  Google Scholar 

  14. Heimbach DM, Warden GD, Luterman A, Jordan MH, Ozobia N, Ryan CM et al (2003) Multicenterpostapproval clinical trial of Integra dermal regeneration template for burn treatment. J Burn Care Rehabil 24(1):42–48. https://doi.org/10.1097/00004630-200301000-00009

    Article  PubMed  Google Scholar 

  15. Yeong EK, Yu YC, Chan ZH, Roan TL (2013) Is artificial dermis an effective tool in the treatment of tendon-exposed wounds? J Burn Care Res 34(1):161–167. https://doi.org/10.1097/BCR.0b013e3182685f0a

    Article  PubMed  Google Scholar 

  16. Stern R, McPherson M, Longaker MT (1990) Histologic study of artificial skin used in the treatment of full-thickness thermal injury. J Burn Care Rehabil 11(1):7–13. https://doi.org/10.1097/00004630-199001000-00003

    Article  CAS  PubMed  Google Scholar 

  17. Bache SE, Watson SB (2011) Bedside application of integra debridement of necrotising fasciitis. J PlastReconstrAesthetSurg 64(4):559–560. https://doi.org/10.1016/j.bjps.2010.07.032

    Article  Google Scholar 

  18. Akhtar S, Hasham S, Abela C, Phipps AR (2006) The use of Integra in necrotizing fasciitis. Burns 32(2):251–254. https://doi.org/10.1016/j.burns.2005.06.009

    Article  PubMed  Google Scholar 

  19. Foucher G, Dallaserra M, Tilquin B, Lenoble E, Sammut D (1994) The Hueston flap in reconstruction of fingertip skin loss: results in a series of 41 patients. J Hand Surg Am 19(3):508–515. https://doi.org/10.1016/0363-5023(94)90072-8

    Article  CAS  PubMed  Google Scholar 

  20. Verbelen J, Hoeksema H, Pirayesh A, Van Landuyt K, Monstrey S (2016) Exposed tibial bone after burns: flap reconstruction versus dermal substitute. Burns 42(2):e31–e37. https://doi.org/10.1016/j.burns.2015.08.013

    Article  PubMed  Google Scholar 

  21. Alet JM, Weigert R, Castede JC, Casoli V (2014) Management of traumatic soft tissue defects with dermal regeneration template: a prospective study. Injury 45(7):1042–1048. https://doi.org/10.1016/j.injury.2013.11.034

    Article  PubMed  Google Scholar 

  22. Taras JS, Sapienza A, Roach JB, Taras JP (2010) Acellular dermal regeneration template for soft tissue reconstruction of the digits. J Hand Surg Am 35(3):415–421. https://doi.org/10.1016/j.jhsa.2009.12.008

    Article  PubMed  Google Scholar 

  23. Seavay JG, Masters ZA, Balazs GC, Tintle SM, Sabino J, Fleming ME, Valerio IL (2016) Use of bioartificial dermal regeneration template for skin restoration in combat casualty injuries. Regen Med 11(1):81–90. https://doi.org/10.2217/rme.15.83

    Article  CAS  Google Scholar 

  24. Abai B, Thayer D, Glat PM (2004) The use of dermal regeneration template (Integra) for acute resurfacing and reconstruction of defects created by excision of giant hairy nevi. PlastReconstrSurg 114(1):162–168. https://doi.org/10.1097/01.prs.0000129078.41960.92

    Article  Google Scholar 

  25. Dantzer E, Queruel P, Salinier L, Palmier B, Quinot JF (2003) Dermal regeneration template for deep hand burns: clinical utility for both early grafting and reconstructive surgery. Br J PlastSurg 56(8):764–774. https://doi.org/10.1016/s0007-1226(03)00366-7

    Article  CAS  Google Scholar 

  26. Shores JT, Hiersche M, Gabriel A, Gupta S (2012) Tendon coverage using artificial skin substitute. J PlastReconstrAesthetSurg 65(11):1544–1550. https://doi.org/10.1016/j.bjps.2012.05.021

    Article  Google Scholar 

  27. Hulsen J, Diederich R, Neumeister MW, Bueno RA Jr (2014) Integra® dermal regeneration template application on exposed tendon. Hand 9(4):539–542. https://doi.org/10.1007/s11552-014-9630-1

    Article  PubMed  Google Scholar 

  28. Weigert R, Leclere FM, Delia G, De Luca L, Al Mutairi K, Casoli V (2015) Long-term patient-reported functional and cosmetic outcomes following severe traumatic foot and ankle wound reconstruction with acellular dermal matrix. J Cosmet Laser Ther 17(6):321–329. https://doi.org/10.3109/14764172.2015.1027231

    Article  PubMed  Google Scholar 

  29. Wolter TP, Noah EM, Pallua N (2005) The use of Integra in an upper extremity avulsion injury. Br J PlastSurg 58(3):416–418. https://doi.org/10.1016/j.bjps.2004.04.008

    Article  CAS  Google Scholar 

  30. Gravvanis AI, Tsoutsos DA, Iconomou T et al (2007) The use of integra artificial dermis to minimize donor-site morbidity after suprafascial dissection of the radial forearm flap. Microsurgery 27(7):583–587. https://doi.org/10.1002/micr.20406

    Article  PubMed  Google Scholar 

  31. Watt AJ, Friedrich JB, Huang JI (2012) Advances in treating skin defects of the hand: skin substitutes and negative-pressure wound therapy. Hand Clin 28(4):519–528. https://doi.org/10.1016/j.hcl.2012.08.010

    Article  PubMed  Google Scholar 

  32. Niu XF, Yi JH, Zha GQ, Hu J, Liu YJ, Xiao LB (2017) Vacuum sealing drainage as a pre-surgical adjunct in the treatment of complex (open) hand injuries: Report of 17 cases. OrthopTraumatolSurg Res 103(3):461–464. https://doi.org/10.1016/j.otsr.2017.01.008

    Article  Google Scholar 

  33. Menn ZK, Lee E, Klebuc MJ (2012) Acellular dermal matrix and negative pressure wound therapy: a tissue-engineered alternative to free tissue transfer in the compromised host. J ReconstrMicrosurg 28(2):139–144. https://doi.org/10.1055/s-0031-1289167

    Article  Google Scholar 

  34. Unglaub F, Ulrich D, Pallua N (2005) Reconstructive surgery using an artificial dermis (Integra): results with 19 grafts. ZentralblChir 130(2):157–161. https://doi.org/10.1055/s-2005-836367

    Article  CAS  Google Scholar 

  35. Schiavon M, Francescon M, Drigo D, Sallom G, Baraziol R, Tesei J, Fraccalanza E, Barbone F (2016) The use of Integra dermal regeneration template versus flaps for reconstruction of full-thickness scalp defects involving the calvaria: a cost-benefit analysis. AesthPlastSurg 40(6):901–907. https://doi.org/10.1007/s00266-016-0768-9

    Article  CAS  Google Scholar 

  36. Kim TG, Choi MK (2018) Secondary contouring of flaps. Arch PlastSurg 45(4):319–324. https://doi.org/10.5999/aps.2018.00542

    Article  Google Scholar 

  37. Elliot D, Adani R, Woo SH, Tang JB (2018) Repair of soft tissue defects in finger, thumb and forearm: less invasive methods with similar outcomes. J Hand SurgEur 43(10):1019–1029. https://doi.org/10.1177/1753193418805698

    Article  Google Scholar 

  38. Rehim SA, Singhal M, Chung KC (2014) Dermal skin substitutes for upper limb reconstruction: current status, indications and contraindications. Hand Clin 30(2):239–252. https://doi.org/10.1016/j.hcl.2014.02.001

    Article  PubMed  PubMed Central  Google Scholar 

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This research did not receive any grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Plastic, Burn and Hand Surgery Departement, FX. Michelet Center, Bordeaux University Hospital (Pellegrin Site), Place Amelie Raba-Leon, 33076, Bordeaux, France

    Hussein Choughri, Romain Weigert, Antoine Heron, Amirouche Dahmam, Marie-Laure Abi-Chahla & Anaïs Delgove

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  1. Hussein Choughri
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Choughri, H., Weigert, R., Heron, A. et al. Indications and functional outcome of the use of integra® dermal regeneration template for the management of traumatic soft tissue defects on dorsal hand, fingers and thumb. Arch Orthop Trauma Surg 140, 2115–2127 (2020). https://doi.org/10.1007/s00402-020-03615-z

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