Reconstruction of complex hand injuries that involve devascularization of digits and extensive soft tissue defects requires careful planning. Management of such injuries includes, but is not limited to, skeletal stabilization, repair of tendon and nerves, revascularization followed by soft tissue coverage. Vein grafts are often required to revascularize the digits. These vein grafts need soft tissue coverage preferably using a flap [1].
The survival of digits is often not certain in severely mangled extremities and affected digits are lost. In addition, the native tissue in the zone of injury takes time to demarcate and it is difficult to determine its viability during the initial surgery [2]. If flap coverage is performed primarily, it might result in inadequate coverage due to possible wound necrosis, expanding the existing defect size. Also, if the fingers do not survive, the patient may need an additional flap in anticipation of a toe-to-hand transfer.
Hence, a temporizing measure before definitive coverage would be very useful in the reconstructive algorithm. Such a procedure would allow time to establish revascularization and demarcate the zone of injury [3]. We describe a temporizing technique using Integra® (Integra LifeScience Corporation, Plainsboro, NJ) and our experience in two cases of devascularized complex hand injuries.
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