Management of Severe Hand Wounds with Integra® Dermal Regeneration Template

Author(s): Weigert R, Choughri H, Casoli V

Source: J Hand Surg 36E:185-193, 2011.

Summary:
The authors report their experience with Integra® for the management of severe traumatic wounds of the hand.  Fifteen complex hand wounds in 15 patients with associated osseous and/or joint/and/or tendon exposure were managed with Integra® placement, dressing changes (with or without negative pressure therapy), and subsequent split-thickness skin grafting.  The treatment was successful in achieving durable, functional, and aesthetic coverage in 13 of 15 cases.  Failure in 1 case was attributed to poor patient compliance, whereas failure in another case was attributed to poor vascularized tissue surrounding an exposed finger flexor tendon. 
 
Two recent reports have documented successful treatment of complex finger wounds using Integra® (Taras et al, JHS Am 2010; Azzena et al, JHS Am 2010).  Integra® is composed of type 1 Bovine collagen and a silicone membrane.  The collagen serves as a dermal regeneration template and the silicone membrane functions as an artificial epidermal barrier.  The silicone membrane is removed after approximately 3 weeks and replaced with a split-thickness or full-thickness skin graft.  This technique eliminates the donor site morbidity of a vascularized local, regional, or distant flap. 
 
Integra® was approved by the US FDA in 1996 for treatment of severe burn wounds where sufficient autograft is not available or not desirable due to the physiological condition of the patient.  The FDA indications were expanded in 2002 to include treatment of disabling scar contractures resulting from severe burns.  Use of this product for the treatment of complex hand wounds unrelated to burns is considered off-label at this time.  However, the reported results are impressive and this product appears to deserve further study.