title: The use of a dermal substitute for simultaneous flap delay and donor site coverage in two cases.
abstract: OBJECTIVE
  Lower extremity traumatic wounds can be difficult to treat owing to limb ischaemia and large zones of injury. Often, muscle or fasciocutaneous flaps are used in the presence of severe open orthopaedic injuries with soft tissue defects. Sometimes local flaps may be the preferred or only option, but may not tolerate being rotated or advanced owing to resulting flap ischaemia. One well-studied technique that can increase the survival of various flaps involves the delay phenomenon.
  
  
  METHODS
  In these case reports, Integra Dermal Regeneration template was used to simultaneously create delayed flaps and to cover the wound and flap donor site so that the donor site could be skin grafted at the time of flap inset.
  
  
  RESULTS
  These cases demonstrate that use of Integra can enhance the delay phenomenon while simultaneously providing coverage of soft tissue defects in preparation for ultimately insetting delayed flaps and better covering donor areas.
  
  
  CONCLUSIONS
  This technique may be applicable to many different flaps in many different anatomic locations and should be considered an option when reconstructing complicated wounds.
  
  
  BACKGROUND
  none.
authors.affiliation: Drexel university College of medicine, Department of Surgery, Division of Plastic Surgery Philadelphia, USA.
authors.forename: Brittany J
authors.initials: BJ
authors.lastname: Behar
authors.forename: Hamid
authors.initials: H
authors.lastname: Abdollahi
authors.forename: Bharat
authors.initials: B
authors.lastname: Ranganath
authors.forename: Azra
authors.initials: A
authors.lastname: Ashraf
authors.forename: Paul M
authors.initials: PM
authors.lastname: Glat
keywords: Dermal Regeneration template; Integra; Lower extremity reconstruction; flap delay; local regional flap; open orthopaedic fracture