title: Reconstruction of skin avulsion injuries of the upper extremity with integra(®) dermal regeneration template and skin grafts in a single-stage procedure.
abstract: BACKGROUND
  Management of skin avulsion injuries of the upper extremity may require coverage with large flaps or skin autografts. Cutaneous grafting is frequently combined with artificial skin to optimize the final functional and cosmetic result. The conventional use of bilaminated dermal substitutes consists of a two-stage procedure and requires long immobilization of the operated area. The purpose of this retrospective study is to evaluate the impact of a dermal regeneration template immediately covered by skin grafts in a one-step procedure for reconstructing skin avulsion injuries of the hand and forearm.
  
  
  METHODS
  We performed this technique in eight patients who presented with extended skin defects of the hand and forearm following skin avulsion injuries. Dimensions of the defects ranged from 160 to 1,250 cm(2). After debridement, Integra(®) Single Layer was applied and covered with unmeshed thin skin autografts; compressive dressings were used for 1 week and mobilization started by the second postoperative week. Histological examination of the grafted areas was performed 2 weeks after surgery. Functional and cosmetic outcome was assessed 12 months postoperatively.
  
  
  RESULTS
  The overall take rate of the dermal substitute and skin graft was 95-98 %. Histological results showed complete incorporation and vascular proliferation of the template, which allowed the neo-vascularization of the overlying autograft. The mean grip strength of the operated hands was at the 83 % of the normal contralateral hands. Pliability and overall appearance of the reconstructed areas was satisfactory (mean Vancouver Scar Scale Score 1.875).
  
  
  CONCLUSIONS
  The use of Integra(®) Single Layer dermal substitute and immediate skin overgrafting consists an alternative reconstructive option for managing extended skin avulsion injuries of the upper extremity; it reduces postoperative immobilization, minimizes donor site morbidity and provides good functional and esthetic results in a single surgical procedure.
authors: Department of Plastic Surgery, Medical School, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Periferiaki Odos, N. Efkarpia, 54603, Thessaloniki, Greece, depydemiri@gmail.com.
authors: Efterpi
authors: E
authors: Demiri
authors: Antonios
authors: A
authors: Papaconstantinou
authors: Dimitrios
authors: D
authors: Dionyssiou
authors: Alexandros
authors: A
authors: Dionyssopoulos
authors: Katerina
authors: K
authors: Kaidoglou
authors: Ioannis
authors: I
authors: Efstratiou
mesh_terms: D000328:Adult; D001134:Arm Injuries / Q000601:surgery*; D002809:Chondroitin Sulfates; D003094:Collagen; D062109:Dermatologic Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012038:Regeneration; D012189:Retrospective Studies; D012867:Skin / Q000293:injuries*; D012879:Skin Physiological Phenomena; D016038:Skin Transplantation; D017768:Skin, Artificial
chemical_list: C114835:integra artificial skin; D002809:Chondroitin Sulfates; D003094:Collagen