Use of Artificial Dermal Substitute as a Bridge in Complex Finger Reconstruction
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Index: WOUNDS. 2012;24(5):120–123.
Abstract: Few reports exist regarding the use of an artificial dermal substitute ([ADS] Integra™) in the treatment of finger injuries. This retrospective case series evaluated the use of ADS as a bridge for finger reconstruction following complex injuries. The authors’ facility treated 26 complex finger injury patients using ADS. Graft take was 92.3% (22/26), with most patients experiencing satisfactory range of motion (88.5% or 23/26). The authors conclude that ADS, as a bridge for reconstruction of complex finger injuries, offers advantages, such as improved contour, functionality, and decreased need for native flaps.
Since its introduction by Yannas and Burke, the artificial dermal substitute (ADS), Integra™ (Integra Lifesciences, Plainsboro, NJ), has had many applications in wound care, such as treating burns, chronic wounds, and contractures.1 The majority of reports reveal improved range of motion, skin quality, and contour with use of ADS in treatment of the aforementioned conditions. Few reports exist regarding the use of ADS in finger injuries. This report presents the authors’ experience with the use of an ADS (Integra) as a bridge for reconstruction of complex finger injuries, in order to demonstrate ADS as a viable alternative to address such injuries and improve outcomes.
Twenty-six patients (22 men and 4 women [43 years ± 16.15 years]) underwent finger reconstruction in the authors’ facility using ADS. The cause for injury was traumatic in 24 and infectious in 2. Two of the 26 patients had been treated initially at different facilities. Both patients were referred to the authors’ facility with post-traumatic contractures following primary closure or native flap failure; both required excision and coverage with ADS. Additionally, 2 of the 26 patients were treated in the authors’ facility only with full-thickness skin grafts (FTSG) for their injuries. Postoperatively, 1 graft failed and 1 developed contracture, both leading to subsequent use of ADS. Preoperative comorbidities included: diabetes (2), tobacco use (7), coronary artery disease (4), history of stroke (1), and hypertension (1). One patient was in chronic renal failure, required daily dialysis, and had arterio-venous Steal Syndrome.
All patients presented with some degree of exposed bone. Sixteen (61.5%) sustained some degree of tip amputation with pulp nail bone (PNB) deficit at initial presentation, and 14 (58.3%) had exposed tendons (Figure 1). Eighteen (69.2%) patients had concomitant fractures, of which 10 (38.5%) were treated with bone debridement, and 6 (23.1%) were treated with open reduction internal fractures. Two (8.3%) patients required ADS after wide debridement to treat finger infection with skin necrosis. At initial presentation, 18 (69.2%) patients were treated with ADS alone, 6 (23.1%) with ADS and local flap or FTSG, and 2 (8.3%) with FTSG only. Eleven patients did not require subsequent coverage, 12 required a pinch FTSG, and 1 required a split-thickness skin graft (STSG). Skin grafts (STSG or FTSG) were bolstered with Xeroform™ petrolatum gauze (Covidien, Mansfield, MA), intraoperatively, and subsequent dressing changes were performed by a Certified Hand Therapist (CHT) with Mepitel® (Mölnlycke Health Care US, LLC, Norcross, GA) 7 to 14 days thereafter.