title: Acellular dermal matrix: New applications for free flap pedicle coverage - A prospective study in 10 patients.
abstract: BACKGROUND
  The goal of lower extremity reconstruction after trauma is the coverage of defects to give patients a healed wound and to let them resume their life, ambulate and return to work, while preventing amputation. In this article, we describe an innovative use of Integra® for free flap pedicle coverage in lower extremity reconstruction.
  
  
  METHODS
  Between January 2011 and December 2015, ten patients, four women and six men, underwent a lower limb reconstruction with an association of free flap and Integra® to cover the flap pedicle. The mean age of the patients was 38.8±15.6 years at the time of surgery (range of 14-59 years). The mean defect size was 102±54 cm2(range of 40-160 cm2). The bone and/or tendons were exposed at the level of the middle third of the leg in 2 cases, at the level of the distal leg in 5 cases and at the level of the foot in 3 cases.
  
  
  RESULTS
  There were no intra-operative complications. Mean size of Integra® needed for flap pedicle coverage was 12.8±2.3 cm2(range 10-15 cm2). The mean follow-up was 41±19 months (range 21-70 months). Revision surgery was necessary in three cases due to haematoma of the pedicle. In these cases, the dermal substitute was easily removed while awaiting revision. This allowed flap survival in all cases. A skin graft was performed after a mean time of 3.4±0.8 weeks post-operatively. Complications at the donor site level included one seroma and a case of hypertrophic scar. Complete healing of both the donor and recipient sites was achieved in all cases.
  
  
  CONCLUSIONS
  The combination of free flap and Integra® appears to be a useful option in covering complex defects in the lower limb. The dermal substitute avoids skin tension and compression of the pedicle. Haematomas of the pedicle, if they occur, are highly visible and thus easy to manage. We hypothesize that the use of dermal substitute for this specific indication of pedicle coverage will expand in the near future.
authors: a Department of Plastic & Reconstructive Surgery, Burn Surgery, Hand Surgery, Centre of Expertise for Sex Reassignment Surgery , University Hospital Bordeaux (CHU), University of Bordeaux, Centre François-Xavier-Michelet, Groupe hospitalier Pellegrin , Place Amélie-Raba-Léon , France.|b Department of Anatomy , University of Bordeaux, Centre François-Xavier-Michelet, Groupe hospitalier Pellegrin , Place Amélie-Raba-Léon , France.|c INSERM U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology , University Hospital Lille , France.
authors: Franck Marie
authors: FM
authors: Leclère
authors: b Department of Anatomy , University of Bordeaux, Centre François-Xavier-Michelet, Groupe hospitalier Pellegrin , Place Amélie-Raba-Léon , France.
authors: Emilie
authors: E
authors: Desnouveaux
authors: a Department of Plastic & Reconstructive Surgery, Burn Surgery, Hand Surgery, Centre of Expertise for Sex Reassignment Surgery , University Hospital Bordeaux (CHU), University of Bordeaux, Centre François-Xavier-Michelet, Groupe hospitalier Pellegrin , Place Amélie-Raba-Léon , France.
authors: H
authors: H
authors: Choughri
authors: a Department of Plastic & Reconstructive Surgery, Burn Surgery, Hand Surgery, Centre of Expertise for Sex Reassignment Surgery , University Hospital Bordeaux (CHU), University of Bordeaux, Centre François-Xavier-Michelet, Groupe hospitalier Pellegrin , Place Amélie-Raba-Léon , France.|b Department of Anatomy , University of Bordeaux, Centre François-Xavier-Michelet, Groupe hospitalier Pellegrin , Place Amélie-Raba-Léon , France.
authors: Vincent
authors: V
authors: Casoli
mesh_terms: D062088:Acellular Dermis; D000293:Adolescent; D000328:Adult; D002809:Chondroitin Sulfates / Q000627:therapeutic use*; D003094:Collagen / Q000627:therapeutic use*; D005260:Female; D058752:Free Tissue Flaps; D000071976:Gracilis Muscle / Q000637:transplantation; D006085:Graft Survival; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D012086:Reoperation; D016038:Skin Transplantation; D064171:Superficial Back Muscles / Q000637:transplantation; D055815:Young Adult
chemical_list: C114835:integra artificial skin; D002809:Chondroitin Sulfates; D003094:Collagen
keywords: Integra®; dermal substitute; free flap; pedicle compression; pedicle coverage; revision surgery