Use of Integra® as a Temporizing Measure Before Definitive Flap Surgery in Mangled Extremities Requiring Revascularization

Complex palm defects with devascularized digits often require vein grafts. This may need to be followed by a free or pedicled flap to resurface the tissue lost and also cover the vein grafts and the anastomosis. However, if the anastomosis fails, or there is marginal wound necrosis, the existing flap would be redundant and a different flap would be needed for coverage. In such situations, a novel approach would be to temporarily cover the anastomotic site with Integra® (Integra LifeScience Corporation, Plainsboro, NJ), until the digit and skin margin vascularity stabilize. This technique can be used to buy time and potentially lessen the need for pedicled or free flap coverage in the first instance. This should be taken into consideration as a viable alternative during revascularization in such cases. In this case report, we present two cases in which we used Integra® as a temporary cover over exposed vein grafts until vascularization was established and a more definitive flap coverage was done. We were able to place the flap directly over the Integra®. This allowed time to determine additional necrosis of the wound margins and the final size of the defect that required coverage. Other advantages of this technique are that Integra® is readily available, there is no donor site morbidity, and the silicone layer which is not directly in contact with the vein graft can be easily peeled off without any traction. A flap or skin graft can be done directly over the collagen layer of the Integra®. Also, having a collagen layer integrated over the vein graft can potentially obviate the need for a flap.