INTRODUCTION : Integra® is widely used for the primary coverage of acute burns. It acts as a scaffold for dermal reconstruction. Deep burns of feet may involve tendon exposures or tendon injuries resulting in functional impairment. CASE REPORT : We report the case of a woman, 17 years old, who sustained deep flame burns of feet and legs in a polytrauma context (10% TBSA burn). After debridment of skin necrosis of the right foot, we noticed exposure of extensor tendons on the dorsum of the foot. The muscle beneath extensor tendons was necrotic and it was carefully debrided. A temporary coverage (allograft) allowed the preservation of tendons until we were sure there was no persistence of necrotic tissue. Then the granulating tissue was completely removed and, in order to obtain a good dermal protection for tendons, we placed an Integra® membrane. The total revascularization was obtained in less than four weeks without any failure, infection or haematoma. A thin epidermal meshed autograft achieved a complete healing. At six months follow-up, the result is good with an useful range of motion of the ankle and may be improved by physiotherapy and pressure therapy. DISCUSSION : Deep burns with tendon exposures result usually in tendon destruction and loss of function. Split-thickness skin grafts do not offer a good protection and leads to an adherent scar. Flap coverage will result in a bulky aspect and an impaired donor site. The use of Integra® results in a supple integument with many similarities to normal skin. The advantages of Integra® are its immediate availability, the reliability of the technique and the quality of functional and cosmetic results. CONCLUSION : In the light of this preliminary result, Integra® appears as a new attractive alternative technique for the coverage of exposed tendons in acute burns.
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