Dermal Substitutes in the Setting of Flap Delay: A Reconstructive Technique to Enhance Flap Viability

摘要

Dermal substitutes (DSs) such as Integra (Integra LifeSciences Corporation, Plainsboro, NJ) have been used extensively to reconstruct burns, traumatic and chronic wounds, and skin excisions from cutaneous cancers. They serve as an important reconstructive tool in the plastic surgeon's armamentarium as they provide wound coverage, maintain a moist environment for wound healing, and enhance the recovery of defects from an aesthetic and functional standpoint.1 DSs are a reliable coverage option that provides a layer of neo-dermis allowing for adequate wound coverage in addition to providing a surface which can later be grafted on. Integra itself is a bilaminate DS in which the dermal layer is composed of bovine collagen and chondroitin-6-sulfate glycosaminoglycan and an epidermal layer of synthetic silicone. Recently, Behar et al., described the novel and successful application of a DS (Integra) combined with the delayed flap technique in two separate cases for the reconstruction of lower extremity traumatic wounds. Flap delay is a common surgical technique that is used to enhance the vascular supply to a flap to improve flap survival. The delayed approach is particularly useful when an increased length-width ratio is needed or when a flap will not tolerate rotation and becomes is-chemic.