A skin substitute (Integra®) in a successful delayed reconstruction of a severe injured hand.

A conscious 44 years old man was admitted to our Plastic Surgery and Burns Unit for 20% TBSA burns after a gas explosion at home with a severe inhalation injury syndrome with a 6% full-thickness burns on the hands and forearms. The dorsal aspect of the left hand, particularly, showed skin and nail loss, with bone and interphalangeal (IP) joints exposure. The extensor tendon apparatus was completely destroyed. Due to the severe inhalation injury syndrome, early surgical management by excision and grafting was not considered. Necrotic tissues were progressively excised and topical Vaseline gauze dressings with silver-sulfadiazine ointment were applied to the surgical wound and repeated every 2 days until the debridement was complete. Surgical treatment was performed on day 20. After necrectomy, a healthy wound bed was obtained allowing Integra1 sheet resurfacing By 4 weeks postoperatively the Integra neodermis was well vascularized. The silicone layer of Integra1 was carefully removed and a thin meshed skin autograft was applied to the neodermis and secured with staples. The left thigh was used as the donor site. Neodermis formation was good and autograft take was 95%, excepted some patchy areas corresponding to the metacarpophalangeal (MP) joints of the second and third long fingers, which healed secondarily. Donor site presented a good healing within 10 days