title: Stacking of a dermal regeneration template for reconstruction of a soft-tissue defect after tumor excision from the palm of the hand: a case report.
abstract: Excision of tumors from the hand often leaves tissue defects with exposed tendons or neurovascular structures that require coverage. Various types of free and pedicled grafts have been described for use in these situations. We present a patient who had a tumor excision in the hand followed by wound coverage with a stacked dermal regeneration template. A 50-year-old man presented with a mass over the palm of the hand. He had an incisional biopsy procedure, the results of which suggested malignancy. He then had wide excision with planned temporary skin coverage with a dermal regeneration template. The dermal template incorporated nicely. With adequate skin coverage the palmar defect still was substantial in terms of depth. This was raised with layering or stacking of the template followed by a split-thickness skin graft. Excellent wound healing and coverage of the defect ultimately were achieved. Additionally the patient went on to obtain full range of motion. Stacking of a dermal regeneration template coupled with split-thickness skin grafting was used to fill a soft-tissue defect over the median and nerve and flexor tendons after wide tumor excision.
authors.affiliation: Duke University Medical Center, Division of Orthopaedic Surgery, Durham, NC, USA.
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Carothers
authors.forename: Brian E
authors.initials: BE
authors.lastname: Brigman
authors.forename: Richard D
authors.initials: RD
authors.lastname: Lawson
authors.forename: Marco
authors.initials: M
authors.lastname: Rizzo
mesh_terms: D003937:Diagnosis, Differential; D005208:Fasciitis / Q000175:diagnosis / Q000601:surgery*; D005354:Fibrosarcoma / Q000175:diagnosis; D006225:Hand / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009236:Myxosarcoma / Q000175:diagnosis; D012038:Regeneration; D012879:Skin Physiological Phenomena; D016038:Skin Transplantation; D017768:Skin, Artificial; D013524:Surgical Flaps; D013717:Tenosynovitis / Q000175:diagnosis / Q000601:surgery