Coverage of Hand Defects with Exposed Tendons: The Use of Dermal Regeneration Template
TAKE-HOME POINTS
- Full thickness skin grafts are generally considered unreliable for coverage of 3-dimensional defects of the hand with tendon exposure.
- Integra (Integra LifeSciences) is a bilayer skin substitute. The “dermal” (lower) layer is a bovine collagen base with glycosaminoglycan chondroitin-6-sulfate while the upper layer is a silicone sheet that acts as a temporary epidermis.
- Despite its popularity of Integra in burn reconstruction, little has been published regarding its utility in complex hand wounds with exposed tendons.
- Small areas of exposed tendons without remaining paratenon can be successfully grafted with Integra.
- In the presence of a healthy wound bed and no necrotic tissue or infection, Integra offers a reconstructive option that allows immediate coverage of complex hand wounds.
Although there is still no perfect answer for wound coverage and closure in the hand with exposed or damaged tendons, DRT certainly performs well as a primary choice by minimizing adhesions; allowing a good ROM; and providing a durable, satisfactory cosmetic outcome. Likewise, an initial treatment with DRT does not preclude later, more elaborate reconstructive efforts, such as local or free flaps, if they continue to be indicated. DRT also does not diminish the ability to revise a tendon reconstruction if a secondary procedure is necessary. In our patient, tendon revision has not been necessary. DRT gives the surgeon a minimally invasive, efficient initial alternative to more labor-intensive, potentially morbid reconstructive procedures, without sacrificing outcome. Therefore, DRT can offer an alternative procedure in the surgeon’s armamentarium for tendon coverage in complex hand defects.
