Article Text

  1. M. Hiersche1,
  2. J. Shores1,
  3. A. Gabriel1,
  4. S. Gupta1
  1. 1Division of Plastic Surgery, Loma Linda University School of Medicine, Loma Linda, CA.


Background Reconstruction of soft tissue defects over exposed tendons remains a problematic process often requiring extensive flap procedures to minimize tendon adhesions to the overlying tissue. Integra is a skin substitute widely used in burn reconstruction and has been used previously in this regard to cover tendinous structures. However, Integra's use in tendon reconstruction and the postoperative functionality of the tendons has not been well documented.

Methods Forty-two patients (35 men and 7 women; mean age 38.6 ± 17.6 years) with exposed tendons of the upper or lower extremity due to trauma (37 patients), cancer excision (2), or chronic wounds (3) were reconstructed using Integra in a typical two-stage procedure. The range in defect size was 4 to 336 cm2. Over the course of follow-up, graft take, tendon function, and adverse complications were assessed.

Results All patients healed with an average split-thickness skin graft take rate of 92.5% ± 6.1 (range 80-100%). Likewise, following physical therapy the 33 patients not lost to follow-up achieved an average range of motion of 91.2% ± 6.5 (range 80-100%). In all cases, the patients did not require postoperative hospitalization.

Conclusion Integra offers a convenient, efficient operative procedure with minimal surgical morbidity, while demonstrating good overall cosmesis and tendon function. Thus, Integra may offer an alternative option for immediate tendon coverage in both the upper and lower extremities.

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