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

• Published in: Archives of orthopaedic and trauma surgery 2020-12, Vol.140 (12), p.2115-2127
• Main Authors: Choughri, Hussein, Weigert, Romain, Heron, Antoine, Dahmam, Amirouche, Abi-Chahla, Marie-Laure, Delgove, Anaïs
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Bones; Child; Chondroitin Sulfates - therapeutic use; Cicatrix; Collagen - therapeutic use; Debridement; Esthetics; Female; Finger Injuries - surgery; Fingers & toes; Fingers - surgery; Hand - surgery; Hand Injuries - surgery; Handsurgery; Humans; Iodine; Male; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Patient Satisfaction; Physical Appearance, Body; Plastic surgery; Reconstructive Surgical Procedures - methods; Retrospective Studies; Skin & tissue grafts; Skin Transplantation - methods; Soft Tissue Injuries - surgery; Surgeons; Surgical techniques; Tendons; Thumb - surgery; Trauma; Treatment Outcome; Wound Infection - surgery; Young Adult
• ISSN: 0936-8051; 1434-3916
• DOI: 10.1007/s00402-020-03615-z

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 cm 2 (range: 3–150 cm 2 ). 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.