Combined use of negative pressure wound therapy and Integra® to treat complex defects in lower extremities after burns.

Deep and extensive burns of lower extremities present a difficult challenge to healthcare professionals. After debridement, bones, tendons or joints are frequently exposed and cannot be covered by simple autografts. Moreover, in the case of major burns, damage to the surrounding areas of skin and the severity of the patient's overall condition, often count against using pedicled or microsurgical flaps. In dealing with such complex wounds, which are difficult to treat, several authors have recommended the combined use of Integra(®) and negative pressure wound therapy (NPWT). They emphasize that NPWT eliminates wound exudate, promotes neovascularisation and cell migration through the Integra(®) matrix while increasing its stability and adherence to the wound bed, as well as decreasing the time needed for its total integration. The case presented here is of a patient with major third-degree flame burns to the lower extremities. After debridement, the external and internal malleolus bilaterally became exposed as well as the partially debrided tendons (Achilles, extensor digitorum longus, long and short peroneus, anterior and posterior tibialis). After ruling out the use of local or microsurgical flaps due to the patient's poor general condition and the presence of burns debrided to the fascia over both lower extremities, we elected to manage the patient with a combined treatment using Integra(®) and NPWT. After three weeks of treatment, the surface layer of the Integra(®) matrix was replaced with autografts. Due to partial loss of the skin grafts, a second autograft was needed. At present the patient is completely healed; he can walk with full flexion-extension of both ankles.