Qazi Uzair, Bhandari Laxminarayan
Hand Surgery, Christine M Kleinert Institute for Hand and Microsurgery, Louisville, USA.
Cureus. 2021 Jun 30;13(6):e16053. doi: 10.7759/cureus.16053. eCollection 2021 Jun.
Complex palm defects with devascularized digits often require vein grafts. This may need to be followed by a free or pedicled flap to resurface the tissue lost and also cover the vein grafts and the anastomosis. However, if the anastomosis fails, or there is marginal wound necrosis, the existing flap would be redundant and a different flap would be needed for coverage. In such situations, a novel approach would be to temporarily cover the anastomotic site with Integra® (Integra LifeScience Corporation, Plainsboro, NJ), until the digit and skin margin vascularity stabilize. This technique can be used to buy time and potentially lessen the need for pedicled or free flap coverage in the first instance. This should be taken into consideration as a viable alternative during revascularization in such cases. In this case report, we present two cases in which we used Integra® as a temporary cover over exposed vein grafts until vascularization was established and a more definitive flap coverage was done. We were able to place the flap directly over the Integra®. This allowed time to determine additional necrosis of the wound margins and the final size of the defect that required coverage. Other advantages of this technique are that Integra® is readily available, there is no donor site morbidity, and the silicone layer which is not directly in contact with the vein graft can be easily peeled off without any traction. A flap or skin graft can be done directly over the collagen layer of the Integra®. Also, having a collagen layer integrated over the vein graft can potentially obviate the need for a flap.
伴有去血管化手指的复杂手掌缺损通常需要静脉移植。这之后可能需要进行游离或带蒂皮瓣移植，以修复缺失的组织，并覆盖静脉移植部位和吻合口。然而，如果吻合失败，或出现边缘伤口坏死，现有的皮瓣就会多余，需要采用不同的皮瓣进行覆盖。在这种情况下，一种新的方法是用Integra®（英特格拉生命科学公司，新泽西州普林斯顿）暂时覆盖吻合部位，直到手指和皮肤边缘的血运稳定。这种技术可用于争取时间，并有可能在一开始就减少对带蒂或游离皮瓣覆盖的需求。在这种情况下的血管重建过程中，应将其视为一种可行的替代方法。在本病例报告中，我们展示了两例使用Integra®作为暴露静脉移植的临时覆盖物的病例，直到建立血运并完成更确切的皮瓣覆盖。我们能够将皮瓣直接放置在Integra®上。这使得有时间确定伤口边缘是否有额外坏死以及需要覆盖的缺损的最终大小。该技术的其他优点包括Integra®容易获得，没有供区并发症，且不直接与静脉移植接触的硅胶层可以轻松剥离而无需任何牵拉。可以直接在Integra®的胶原层上进行皮瓣或植皮。此外，在静脉移植上整合一层胶原层可能无需皮瓣。
