Artificial Skin (Integra” Dermal Regeneration Template) for Closure of Lower Extremity Wounds:

Over a 2-year period, 31 lower extremity wounds in 16 patients (12-82 years old) were treated with a dermal regeneration template (Integra ) to enhance healing. Wounds treated included chronic leg ulcers (four venous, five ischemic, two rheumatoid), as well as skin cancer (18) and benign lesion (one congenital nevus) excision sites. Once the outer silicone layer was removed from the regenerated dermis, the wounds were autografted (eight patients) or left to heal by secondary intention (23 patients). Of the wounds that were autografted, five were successful. The split-thickness skin grafts that failed involved ischemic wounds in which the dermal regeneration template was used to cover exposed tendon. When the dermal regeneration template was used over exposed tendon, granulation tissue coverage was stimulated but failed to support autografts probably due to tissue movement. When the dermal regeneration template was kept in place for a prolonged time (2.5 months), healing over the tendon in one patient progressed via secondary intention to completion. The dermal regeneration template was a convenient dressing for wounds of the lower extremity because there was less pain, less drainage, and a decreased need for frequent dressing changes; that is, weekly dressing changes were adequate. The longest time the silicone layer of the dermal regeneration template was kept in place as a long-term dressing was for 8 months to treat a venous ulcer. None of the wounds appeared to enlarge or significantly worsen secondary to the dermal regeneration template. Infection was responsible for four early (1 week postoperatively) sloughs of the silicone layer of the dermal regeneration template and one delayed (2.5 months) slough of the silicone. Of all the wounds, 25 are healed, five are under continuing treatment, and one was unavailable for follow-up. Overall, our experience suggests that the dermal regeneration template is a valuable addition to chronic and acute wound management on the lower extremity.