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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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The use of Integra® Dermal Regeneration Template (IDRT) in the reconstruction of post-traumatic soft-tissue defects of the dorsum aspect of the hand and/or fingers

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  • presenting/speaker Hussein Choughri - University Hospital of Bordeaux-Pellegrin, Michelet Centre, Bordeaux, France
  • Elias Sawaya - University Hospital of Bordeaux-Pellegrin, Michelet Centre, Bordeaux, France
  • Amirouche Dahmam - University Hospital of Bordeaux-Pellegrin, Michelet Centre, Bordeaux, France
  • Philippe Pelissier - University Hospital of Bordeaux-Pellegrin, Michelet Centre, Bordeaux, France

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-808

doi: 10.3205/19ifssh0412, urn:nbn:de:0183-19ifssh04123

Published: February 6, 2020

© 2020 Choughri et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Traumatic injuries of the dorsum aspect of the hand and/or fingers often leave soft-tissue defects with exposed bone, joint, and/or tendon. Required treatment includes skin grafting, local rotational, pedicle or free flap. The purpose of this study was to report our experience with use of Integra® dermal regeneration template (IDRT) followed by delayed split-thickness skin grafting (STSG) for management of complex dorsum soft tissue defects.

Methods: A prospective study was conducted on all patients sustaining dorsal traumatic soft tissue-defects of the hand and/or fingers with exposed bone, joint, and/or tendon, from September 2008 to October 2013, who were treated with IDRT, followed by STSG. Integra® grafting was performed 12 times in 14 wounds, 9 men and 3 women were included. The mean age was 37± 9 years (6-79). The dominant hand was involved in 5 cases (42%). The IDRT was applied to 6 hands, 4 fingers, 1 thumb and 3 hands and forearm. The mechanism of injury includes Do-it-Yourself accidents (DIY) in 3 cases, public roads in 5 cases, degloving injury in 1 case, necrotizing fasciitis in 2 cases and a work accident in 1 case.

Results and Conclusions: Mean follow-up of 48±6 months (27-85 months). Days from injury to Integra® application were on average of 6 days (0-24), and from Integra® placement to STSG an average of 27 days (21-41). The size of residual soft tissue defect ranged an average of 17cm² (6-150). Integra® and subsequent STSG take rate was 100% and the cosmetic results assessed with the Vancouver Scale was an average of 2 (1-4). In a case, there were defect of the extensor pollicis longus tendon, which required two staged tendon grafting reconstruction, with silastic rod placement during the first stage, followed by autogenous tendon graft 4 months later.

In conclusion, IDRT combined with secondary split-thickness skin grafting is an effective method for the treatment of wounds defects located of the dorsum aspect of the hand and/or fingers, with exposed tendon and/or bone and joint, with good functional and aesthetic results. This can potentially lessen the need for local rotational or free flap coverage. Moreover, in case of failure this technique does not cut the bridges to traditional repair.