Use of Integra for Coverage of Tendons in Acute Deep Burnt ...



Use of Integra for Coverage of Tendons in Acute Deep Burnt Feet

Jean-Claude Castède, MD, Vincent M Casoli, MD, Ciprian Isacu, MD, Hassan Seghrouchni, MD, Gérard Perro, MD, Raymond Sanchez, MD, Marcel Cutillas, MD.

Introduction :

Integra® is a bilayered extracellular matrix widely used for the primary coverage of acute burns [1,2,3,4,5,6,7]. It acts as a scaffold for dermal reconstruction [8].

Deep burns of feet may involve tendon exposures or injuries resulting in functional impairment.

The experience acquired with Integra® in reconstruction of burn scars and burn deformities leads us to use the same procedure in acute skin defects exposing tendons [6,7,9,10].

Case Report :

We report the case of a young woman, 17 years old, who sustained deep flame burns of feet, ankles and distal thirds of the legs in a polytrauma context during a traffic accident (10% TBSA burn).

After debridment of skin necrosis of the right foot, we noticed exposure of extensor tendons on the dorsum of the foot and ligaments of the ankle joint. The muscle beneath extensor tendons (extensor digitorum brevis) was necrotic and it was carefully debrided.

A temporary coverage was obtained with a skin allograft for the preservation of tendons until we were sure there was no persistence of necrotic tissue.

Then the granulating tissue was completely removed (Figure 1) and, in order to obtain a good dermal protection for tendons and ligaments, we placed an Integra® membrane (Figure 2) dressed with silver impregnated nylon (Acticoat®).

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Figure 1: Clinical aspect after complete debridment

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Figure 2: Coverage by Integra

The total revascularization of Integra® dermal component was obtained in less than four weeks without any failure, infection or haematoma.

After removal of the silicon layer, a thin epidermal meshed autograft was necessary to achieve a complete healing (Figures 3 and 4).

At six months follow-up, the result is good with an useful range of motion of the ankle and may be improved by physiotherapy and pressure therapy (Figures 5 and 6).

Discussion :

Deep burns with tendons exposures result usually in tendon destruction and loss of function.

Skin grafting with split-thickness skin grafts on granulating tissue can’t often be done and leads to an adherent scar.

Flap coverage with fascio-cutaneous or free flaps, despite the technical difficulties, is the usual technique for coverage of tendon exposures, but it will result in a bulky aspect and an impaired donor site.

The use of Integra® results in a supple integument with many similarities to normal skin. The advantages of Integra® are its immediate availability in large amounts, the reliability of the technique and the quality of functional and cosmetic results.

Conclusion :

In the light of this preliminary result, Integra® appears as a new attractive alternative technique for the coverage of exposed tendons in acute burns.

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Figure 3: Revascularization of Integra

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Figure 4: Skin grafting

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Figures 5 and 6: Aspect and range of motion at 6 months follow-up

References

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7. Dantzer E, Queruel P, Salinier L, Palmier B, Quinot JF.

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Ann Chir Plast Esthet., 46(3):173-189, Jun 2001.

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Br J Plast Surg., 54(8):659-664, Dec 2001.

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