The use of Integra(TM) as a novel technique in deep burn foot management()

Deep burns in patients with co-morbidities carry a significant challenge for surgeons. The use of synthetic skin substitutes has played an increasingly important role in tissue reconstruction. Integra(TM) is an artificial dermal substitute that allows temporary coverage after burn excision. The main advantages of this bi-layered template are its immediate availability, optimal scarring and decreased requirement for donor tissue. However, the downsides are the requirement for complex wound care, risk of infection and two stage procedure that can be both costly and prolong the stay in hospital. Here, we present the case of a patient with deep burns to the plantar aspect of both feet. Given the patient's medical history of diabetes, hypertension and peripheral neuropathy, we elected to use Integra(TM) in combination with negative pressure wound therapy. Three weeks after the application of the Integra(TM) matrix, the surface layer was replaced with autograft. At discharge, the patient was fully ambulatory and six months post-operatively this status was maintained without significant graft breakdown. To the best of our knowledge, the use of Integra(TM) and split thickness skin graft in the management of full thickness burns to the plantar aspect of the feet has not been reported previously. Overall, our experience with Integra(TM) in this setting was found to be satisfactory and can be considered as a promising treatment option in acute burn resurfacing.